Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000100011
Brazilian Journal of Anesthesiology
Review Article

Atelectasias durante anestesia: fisiopatologia e tratamento

Atelectasis during anesthesia: pathophysiology and treatment

Luiz Marcelo Sá Malbouisson; Flávio Humberto; Roseny dos Reis Rodrigues; Maria José Carvalho Carmona; José Otávio Costa Auler Jr.

Downloads: 0
Views: 992

Resumo

JUSTIFICATIVA E OBJETIVOS: O colapso pulmonar intra-operatório é uma complicação de elevada incidência em pacientes submetidos à intervenção cirúrgica sob anestesia geral com relaxamento/paralisia da musculatura. Essa complicação está associada à piora das trocas gasosas no intra-operatório e, em alguns casos, necessidade de suporte respiratório prolongado no período pós-operatório. Os objetivos deste estudo foram revisar os aspectos fisiopatológicos da formação de atelectasias durante anestesia geral e as possíveis manobras terapêuticas para prevenir e tratar essa complicação. CONTEÚDO: Nesta revisão, os conceitos sobre a incidência de atelectasias intra-operatórias, os fatores relacionados com o seu desenvolvimento, tanto mecânicos quanto associados ao ajuste do respirador durante procedimento cirúrgico, os aspectos do diagnóstico e as estratégias de prevenção e tratamento foram abordados de maneira sistemática. CONCLUSÕES: A compreensão dos mecanismos relacionados com o desenvolvimento do colapso pulmonar durante o período intra-operatório, assim como o seu tratamento, pode contribuir para a redução da incidência de complicações pulmonares pós-operatórias, o tempo de recuperação e os custos hospitalares.

Palavras-chave

COMPLICAÇÕES, colapso pulmonar, VENTILAÇÃO, VENTILAÇÃO, VENTILAÇÃO

Abstract

BACKGROUND AND METHODS: The incidence of intraoperative pulmonary collapse is elevated in patients undergoing surgery under general anesthesia with muscle relaxation/paralysis. This complication is associated with worsening intraoperative gas exchange and, in some cases, the need for prolonged postoperative respiratory support. The objective of this report was to review the pathophysiological aspects of atelectasis during general anesthesia and possible therapeutic maneuvers that could prevent and treat this complication. CONTENTS: This review discusses the concepts about the incidence of intraoperative atelectasis, factors that influence their development, both mechanical and those related to mechanical ventilator settings during the surgery, diagnostic criteria, and strategies to prevent and treat this complication. CONCLUSIONS: Understanding of the mechanisms related with the development of intraoperative pulmonary collapse, as well as its treatment, can contribute to reduce the incidence of postoperative pulmonary complications, the length of recovery and hospital costs.

Keywords

COMPLICATIONS, COMPLICATIONS, VENTILATION, VENTILATION, VENTILATION

References

Pasteur W. Active lobar collapse of the lung after abdominal operations. Lancet. 1910;2:1080-1083.

Nunn JF, Payne JP. Hypoxaemia after general anaesthesia. Lancet. 1962;2:631-632.

Grigor KC. Atelectasis during anaesthesia (spontaneous atelectasis). Anaesthesia. 1954;9:185-189.

Tibbs DJ. Hypoxaemia after anaesthesia. Lancet. 1965;14:1105-1106.

Bendixen HH, Hedley-Whyte J, Laver MB. Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation: A concept of atelectasis. N Engl J Med. 1963;269:991-996.

Bergman NA. Distribution of inspired gas during anesthesia and artificial ventilation. J Appl Physiol. 1963;18:1085-1089.

Bendixen HH. Atelectasis and shunting. Anesthesiology. 1964;25:595-596.

Dery R, Pelletier J, Jacques A. Alveolar collapse induced by denitrogenation. Can Anaesth Soc J. 1965;12:531-557.

Moller JT, Johannessen NW, Berg H. Hypoxaemia during anaesthesia: an observer study. Br J Anaesth. 1991;66:437-444.

Lundquist H, Hedenstierna G, Strandberg A. CT-assessment of dependent lung densities in man during general anaesthesia. Acta Radiol. 1995;36:626-632.

Magnusson L, Zemgulis V, Wicky S. Atelectasis is a major cause of hypoxemia and shunt after cardiopulmonary bypass: an experimental study. Anesthesiology. 1997;87:1153-1163.

Gale GD, Teasdale SJ, Sanders DE. Pulmonary atelectasis and other respiratory complications after cardiopulmonary bypass and investigation of aetiological factors. Can Anaesth Soc J. 1979;26:15-21.

Tenling A, Hachenberg T, Tyden H. Atelectasis and gas exchange after cardiac surgery. Anesthesiology. 1998;89:371-378.

Vargas FS, Cukier A, Terra-Filho M. Influence of atelectasis on pulmonary function after coronary artery bypass grafting. Chest. 1993;104:434-437.

Vargas FS, Terra-Filho M, Hueb W. Pulmonary function after coronary artery bypass surgery. Respir Med. 1997;91:629-633.

Pelosi P, D'Andrea L, Vitale G. - Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;149:8-13.

Tomiyama N, Takeuchi N, Imanaka H. Mechanism of gravity-dependent atelectasis: Analysis by nonradioactive xenon-enhanced dynamic computed tomography. Invest Radiol. 1993;28:633-638.

Agostini E, D'Angelo E, Bonanni MV. The effect of the abdomen on the vertical gradient of pleural surface pressure. Respiration Physiol. 1970;8:332-346.

Agostini E, D'angelo E, Bonanni MV. Topography of pleural surface pressure above resting volume in relaxed animals. J Appl Physiol. 1970;29:297-306.

Nunn JF. Respiratory Aspects of Anaesthesia. Applied Respiratory Physiology. 1987:350-370.

Froese AB, Bryan AC. - Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology. 1974;41:242-255.

Puybasset L, Cluzel P, Chao N. A computed tomography scan assessment of regional lung volume in acute lung injury. Am J Respir Crit Care Med. 1998;158:1644-1655.

Reber A, Nylund U, Hedenstierna G. - Position and shape of the diaphragm: implications for atelectasis formation. Anaesthesia. 1998;53:1054-1061.

Eichenberger A, Proietti S, Wicky S. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95:1788-1792.

Hoffman EA. Effect of body orientation on regional lung expansion: a computed tomographic approach. J Appl Physiol. 1985;59:468-480.

Hyatt RE, Bar-Yishay E, Abel MD. Influence of the heart on the vertical gradient of transpulmonary pressure in dogs. J Appl Physiol. 1985;58:52-57.

Malbouisson LM, Busch CJ, Puybasset L. Role of the heart in the loss of aeration characterizing lower lobes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2000;161:2005-2012.

Strandberg A, Hedenstierna G, Tokics L. Densities in dependent lung regions during anaesthesia: atelectasis or fluid accumulation?. Acta Anaesthesiol Scand. 1986;30:256-259.

Yang QH, Kaplowitz MR, Lai-Fook SJ. Regional variations in lung expansion in rabbits: prone vs. supine positions. J Appl Physiol. 1989;67:1371-1376.

Brismar B, Hedenstierna G, Lundquist H. Pulmonary densities during anesthesia with muscular relaxation: a proposal of atelectasis. Anesthesiology. 1985;62:422-428.

Warner DO, Warner MA, Ritman EL. Atelectasis and chest wall shape during halothane anesthesia. Anesthesiology. 1996;85:49-59.

Puybasset L, Cluzel P, Chaw N. Distribution of volume reduction in post operative acute lung injury- factors influencing peep-induced alveolar recruitment. Br J Anaesth. 1997;78(^s1):A380.

Puybasset L, Cluzel P, Gusman P. Regional distribution of gas and tissue in acute respiratory distress syndrome: I. Consequences for lung morphology. Intensive Care Med. 2000;26:857-869.

Joyce CJ, Williams AB. Kinetics of absorption atelectasis during anesthesia: a mathematical model. J Appl Physiol. 1999;86:1116-1125.

Rothen HU, Sporre B, Engberg G. Reexpansion of atelectasis during general anaesthesia may have a prolonged effect. Acta Anaesthesiol Scand. 1995;39:118-125.

Rothen HU, Sporre B, Engberg G. Atelectasis and pulmonary shunting during induction of general anaesthesia can they be avoided?. Acta Anaesthesiol Scand. 1996;40:524-529.

Goll V, Akca O, Greif R. Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting. Anesth Analg. 2001;92:112-117.

Kotani N, Hashimoto H, Sessler DI. Supplemental intraoperative oxygen augments antimicrobial and proinflammatory responses of alveolar macrophages. Anesthesiology. 2000;93:15-25.

Greif R, Akca O, Horn EP. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection: Outcomes Research Group. N Engl J Med. 2000;342:161-167.

Nunn JF. Applied Respiratory Physiology. 1987.

Woo SW, Berlin D, Hedley-Whyte J. Surfactant function and anesthetic agents. J Appl Physiol. 1969;26:571-577.

Friedrich B, Schmidt R, Reiss I. Changes in biochemical and biophysical surfactant properties with cardiopulmonary bypass in children. Crit Care Med. 2003;31:284-290.

Griese M, Wilnhammer C, Jansen S. Cardiopulmonary bypass reduces pulmonary surfactant activity in infants. J Thorac Cardiovasc Surg. 1999;118:237-244.

Bendixen HH, Bullwinkel B, Hedley-Whyte J. Atelectasis and shunting during spontaneous ventilation in anesthetized patients. Anesthesiology. 1964;25:297-301.

Dreyfuss D, Basset G, Soler P. Intermittent positive-pressure hyperventilation with high inflation pressures produces pulmonary microvascular injury in rats. Am Rev Resp Dis. 1985;132:880-884.

Dreyfuss D, Saumon G. Role of tidal volume, FRC, and end-inspiratory volume in the development of pulmonary edema following mechanical ventilation. Am Rev Respir Dis. 1993;148:1194-1203.

Neumann P, Rothen HU, Berglund JE. Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiol Scand. 1999;43:295-301.

Lu Q, Capderou A, Cluzel P. A computed tomographic scan assessment of endotracheal suctioning-induced bronchoconstriction in ventilated sheep. Am J Respir Crit Care Med. 2000;162:1898-1904.

Dreyfuss D, Saumon G. Synergistic interaction between alveolar floading and distention during mechanical ventilation. Am J Respir Crit Care Med. 1996;153:A12.

Dreyfuss D, Soler P, Saumon G. Mechanical ventilation-induced pulmonary edema: Interaction with previous lung alterations. Am J Resp Crit Care Med. 1995;151:1568-1575.

Gattinoni L, Pelosi P, Pesenti A. CT scan in ARDS: clinical and physiopathological insights. Acta Anaesthesiol Scand. 1991:87-96.

Gattinoni L, Pesenti A. The concept of "baby lung". Intensive Care Med. 2005;31:776-784.

Brooks-Brunn JA. Postoperative atelectasis and pneumonia. Heart Lung. 1995;24:94-115.

Mead J, Collier C. Relation of volume history of lungs to respiratory mechanics in anesthetized dogs. J Appl Physiol. 1959;14:669-678.

Ferris BG Jr, Pollard DS. Effect of deep and quiet breathing on pulmonary compliance in man. J Clin Invest. 1960;39:143-149.

Rothen HU, Sporre B, Engberg G. Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth. 1993;71:788-795.

Magnusson L, Zemgulis V, Tenling A. Use of a vital capacity maneuver to prevent atelectasis after cardiopulmonary bypass: an experimental study. Anesthesiology. 1998;88:134-142.

Tusman G, Bohm SH, Tempra A. Effects of recruitment maneuver on atelectasis in anesthetized children. Anesthesiology. 2003;98:14-22.

Pelosi P, Caironi P, Bottino N. Positive end expiratory pressure in anesthesia. Minerva Anestesiol. 2000;66:297-306.

Pelosi P, Ravagnan I, Giurati G. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology. 1999;91:1221-1231.

5dd6d0ed0e88254b6513f286 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections