Ventilação mecânica protetora, por que utilizar?

Emerson Seiberlich; Jonas Alves Santana; Renata de Andrade Chaves; Raquel Carvalho Seiberlich

doi:10.1590/S0034-70942011000500015

Artigo de Revisão

Ventilação mecânica protetora, por que utilizar?

Protective mechanical ventilation, why use it?

Emerson Seiberlich; Jonas Alves Santana; Renata de Andrade Chaves; Raquel Carvalho Seiberlich

http://dx.doi.org/10.1590/S0034-70942011000500015 Braz J Anesthesiol, vol.61, n5, p.663-667, 2011

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Resumo

JUSTIFICATIVA E OBJETIVOS: As estratégias de ventilação mecânica (VM) vêm sofrendo modificações nas últimas décadas, com tendência ao uso de volumes correntes (VC) cada vez menores. Porém, em pacientes sem lesão pulmonar aguda (LPA) ou SARA (síndrome da angústia respiratória do adulto), o uso de VC altos ainda é muito comum. Estudos retrospectivos sugerem que o uso dessa prática pode estar relacionado à LPA associada à ventilação mecânica. O objetivo desta revisão é buscar evidências científicas que norteiem uma VM protetora para pacientes com pulmões sadios e sugerir estratégias para ventilar adequadamente um pulmão com LPA/SARA. CONTEÚDO: Realizou-se revisão com base nos principais artigos que englobam o uso de estratégias de ventilação mecânica. CONCLUSÕES: Ainda faltam estudos consistentes para que se determine qual seria a melhor maneira de ventilar um paciente com pulmão sadio. As recomendações dos especialistas e as atuais evidências apresentadas neste artigo indicam que o uso de um VC inferior a 10 mL.kg-1 de peso corporal ideal, associado à pressão expiratória final positiva (PEEP) > 5 cmH2O e sem ultrapassar uma pressão de platô de 15 a 20 cmH2O, poderia minimizar o estiramento alveolar no final da inspiração e evitar possível inflamação ou colabamento alveolar.

Palavras-chave

COMPLICAÇÕES, EQUIPAMENTOS, EQUIPAMENTOS, VENTILAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Mechanical ventilation (MV) strategies have been modified over the last decades with a tendency for increasingly lower tidal volumes (VT). However, in patients without acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) the use of high VTs is still very common. Retrospective studies suggest that this practice can be related to mechanical ventilation-associated ALI. The objective of this review is to search for evidence to guide protective MV in patients with healthy lungs and to suggest strategies to properly ventilate lungs with ALI/ARDS. CONTENTS: A review based on the main articles that focus on the use of strategies of mechanical ventilation was performed. CONCLUSIONS: Consistent studies to determine which would be the best way to ventilate a patient with healthy lungs are lacking. Expert recommendations and current evidence presented in this article indicate that the use of a VT lower than 10 mL.kg-1, associated with positive endexpiratory pressure (PEEP) > 5 cmH2O without exceeding a pressure plateau of 15 to 20 cmH2O could minimize alveolar stretching at the end of inspiration and avoid possible inflammation or alveolar collapse.

Keywords

Respiration, Artificial, Ventilator-Induced Lung Injury, Pulmonary Atelectasis, Positive Pressure Respiration

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Ventilação mecânica protetora, por que utilizar?

Protective mechanical ventilation, why use it?

Emerson Seiberlich; Jonas Alves Santana; Renata de Andrade Chaves; Raquel Carvalho Seiberlich

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