medigraphic.com
ISSN 1810-2352 (Print)

2017, Number 4

<< Back Next >>

Rev Cub Med Int Emerg 2017; 16 (4)

Implementation of an alveolar recruitment maneuver in ventilated patients

Guirola PJJ, Gil CB, Camacho AV, Alvarado BK, Iglesias AN

Language: Spanish
References: 37
Page: 104-119
PDF size: 629.16 Kb.


ABSTRACT

Introduction: alveolar recruitment maneuvers improve oxygenation and ventilation, but its effect on mortality is not well studied.
Objective: to evaluate the effects of a variant of alveolar recruitment maneuver in relation with the incidence of complications, days of ventilation, ICU stay and mortality rate in ventilated patients.
Method: an experimental trial was carried out with a historical control. The control group included 97 ventilated patients without recruitment maneuvers admitted from 2010 to 2012 and the experimental group with 101 patients who received the maneuver from 2013 to 2015 in the ICU of the University Hospital of “Ciego de Avila”.
Results: both groups were homogenous in terms of age, causes of ventilation and prognosis according to APACHE II, Murray scale and definition of Berlin. The means of ventilation days and the ICU stay were 6.8 and 8.4 days at the control group and 6.6 and 8.1 days at the experimental one. The mortality rate in the study group was 38.6% and in the control group was 52.6%. In the 82.2% of the patients in the experimental group there were no complications due to mechanical ventilation.
Conclusions: the study group had a mortality rate lower than predicted by the used scales as well as lower than the control group mortality rate. The incidence of complications was lower in the maneuvering group and the most frequent adverse effects were transient hypotension and episodes of desaturation.


REFERENCES

  1. Arencibia Hernández F, Soto Figueroa R. Daño pulmonar inducido por la ventilación mecánica. Rev. Chilena de Med. Intensiva. 2010; 25(4): 205-210 Disponible en: https://www.researchgate.net/profile/Francisco_Arancibia/publication/266484600_Dano_pulmonar_inducido_por_la_ventilacion_mecanica/links/54cbd9b90cf298d65659a52a.pdf

  2. Slutsky AS, Ranieri VM. Complicaciones de la asistencia respiratoria mecánica. Injuria pulmonar inducida por el respirador. N Engl J Med. 2013; 369:2126-36.

  3. López Sánchez M. Complicaciones de la ventilación mecánica. Libro Electrónico de Medicina Intensiva. ISSN 1578-7710. Sección 11. Insuficiencia respiratoria y ventilación mecánica. Capítulo 10. Ed. 1ª, 2008.

  4. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. New England Journal of Medicine. 1998; 338: 347-54. Disponible en: http://www.nejm.org/doi/full/10.1056/NEJM19980205338060

  5. Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. New England Journal of Medicine. 2000; 342(18): 1301-8. Disponible en: http://www.nejm.org/doi/full/10.1056/NEJM200005043421801

  6. Treschan TA, Beiderlinden M. Role of recruitment maneuvers for lung-protective ventilation in the operating room remains unclear. Anesthesiology [Internet]. 2015[citado 8 Jul 2016]; 122:472-473. Disponible en: http://anesthesiology.pubs.asahq.org/article.aspx?articleID=2091880

  7. Dyhr T, Nygard E, Larsson A. Both lung recruitment maneuver and PEEP are needed to increase oxygenation and volume after cardiac surgery. Acta Anaesthesiol Scand, 2004; 48:187-197 Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.0001-5172.2004.00300.x/full

  8. Oliveira Gonçalves L, Días Cicarelli D. Maniobra de Reclutamiento Alveolar en Anestesia: Como, Cuando y Por Qué Utilizarla. Rev Bras Anestesiol. 2005; 55: 6: 617–621 Disponible en: www.scielo.br/whalecom0/pdf/rba/v55n6/en_v55n6a06.pdf

  9. Fan E, Elizabeth Wilcox M, Brower RG, Stewart TE, MehtaS, Lapinsky SE, et al. Recruitment Maneuvers for Acute Lung Injury A. Systematic Review. Am J Respir Crit Care Med [Internet]. 2008[citado 5 Nov 2008]; 178(11):1156-1163. Disponible en: http://ajrccm.atsjournals.org/content/current

  10. Hodgson C, Keating, Holland AE, Davies AR, Smirneos L, Bradley SJ. Maniobras de reexpansión para adultos con lesión pulmonar aguda sometidos a asistencia respiratoria mecánica (Revisión Cochrane tra-ducida) [Internet]. Biblioteca Co-chrane Plus; 2009[citado 5 Oct 2009]; 3: [aprox. 9 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006667.pub2/pdf/standard

  11. Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Resp Dis [Internet]. 1988[citado 6 Feb 2011]; 138:720-3. Disponible en: http://www.atsjournals.org/doi/full/10.1164/ajrccm/138.3.720

  12. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system.Crit Care Med [Internet].1985 Oct [citado 6 Feb 2011]; 13(10):818-29. Disponible en: http://journals.lww.com/ccmjournal/Abstract/1985/10000/APACHE_II__A_severity_of_disease_classification.9.aspx

  13. Acute Respiratory Distress Syndrome. The Berlin Definition. JAMA. 2012[citado 13 Julio 2012]; 307(23): Disponible en: http://jama.jamanetwork.com/

  14. Núñez Betancourt A, Ramos Fernández O. Factores pronósticos de mortalidad del síndrome de distrés respiratorio agudo. Rev Cub Med Int Emerg [Internet]. 2015 [citado 6 Feb 2016]; 14(2):49-61. Disponi-ble en: http://www.medigraphic.com/pdfs/revcubmedinteme/cie-2015/cie152g.pdf

  15. Gómez Cortés LA, Bernal Ramírez OJ. Caracterización de los pacientes críticos ventilados en la Fundación Santa Fe de Bogotá 2009 a 2013[Internet]. Venezuela: Fundación Santa Fe de Bogotá [Internet]. 2013[citado 12 Nov 2013]: [aprox. 12 pantallas]. Disponible en: http://repository.urosario.edu.co/handle/10336/4633

  16. Añon JM, Gómez Tello V, González E, Córcoles V, Quintana M, de Lorenzo AG, et al. Pronóstico de los ancianos ventilados mecánicamente en la UCI. Medicina intensiva [Internet]. 2013[citado 6 Feb 2014]; 37(3):149-155. Disponible en: http://www.sciencedirect.com/science/article/pii/S0210569112001428

  17. Izhakian S, Buchs AE. Characteri-zation of Patients who were Mechanically Ventilated in General Medicine Wards. Isr Med Assoc J. 2015;17(8):496-9 Disponible en: https://www.ima.org.il/imaj/viewarticle.aspx?aid=3720

  18. Gajic O, Dabbagh O, Park PK, Adesanya A, Chang SY, Hou P, et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. American Journal of Respiratory and Critical Care Medicine. 2011; 183(4):462-470. . Disponible en: Phttp://www.atsjournals.org/doi/abs/10.1164/rccm.201004-0549OC

  19. Spieth PM, Güldner A, Uhlig C, Bluth T, Kiss T, Schultz MJ, et al. Variable versus conventional lung protective mechanical ventilation during open abdominal surgery: study protocol for a randomized controlled trial. Trials 2014; 15: 155 Disponible en: https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-15-155

  20. Hartland BL, Newell TJ, Damico N. Alveolar recruitment maneuvers under general anesthesia: a systematic review of the literature. RespirCare 2015; 60: 609-620 Disponible en: http://rc.rcjournal.com/content/60/4/609.short

  21. Silva PL, Moraes L, Santos RS, Samary C, Ramos MB, Santos CL, et al. Recruitment maneuvers modulate epithelial and endothelial cell response according to acute lung injury etiology. Crit Care Med [Internet]. 2013[citado 6 Feb 2014]; 41: e256-e265. Disponible en: http://journals.lww.com/ccmjournal/Abstract/2013/10000/Recruitment_Maneuvers_Modulate_Epithelial_and.40.aspx

  22. Keenan JC, Formenti P, Marini JJ. Lung recruitment in acute respiratory distress syndrome: what is the best strategy? Curr Opin Crit Care. 2014; 20: 63-68 Disponible en: http://journals.lww.com/co-criticalca-re/Abstract/2014/02000/Lung_recruit-ment_in_acute_respiratory_distress.11.aspx

  23. Fernández-Bustamante A, Hashimoto S, Serpa Neto A, Moine P, Vidal Melo MF, Repine JE. Perioperative lung protective ventilation in obese patients. BMC Anesthesiol[Internet]. 2015[citado 6 Feb 2016]; 15: 56. Disponible en: https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-015-0032-x

  24. Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013; 369:428–437. Disponible en: http://www.nejm.org/doi/full/10.1056/NEJMoa1301082

  25. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016; 23; 315(8):788-800. Disponible en: http://jamanetwork.com/journals/jama/fullarticle/2492877

  26. Suzumura EA, Figueiró M, Normilio-Silva K, Laranjeira L, Oliveira C, Buehler AM, et al. Effects of alveolar recruitment maneuvers on clinical outcomes in patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Intensive Care Med. 2014; 40: 1227-1240. Disponible en: http://link.springer.com/article/10.1007/s00134-014-3413-6

  27. Caballero López A. Temas de ventilación mecánica [Internet]. Santa Clara: Hospital Universitario Arnaldo Milián Castro Servicio de Terapia Intensiva; 2010[citado 3 Feb 2017]: [aprox. 18 pantallas]. Disponible en: http://tesis.repo.sld.cu/249/1/Caballero_L%C3%B3pez.pdf

  28. Brito Cruz A, Alonso Oviedo PA, Ones García A, Retamero Rodríguez A. Comportamiento de la ventilación mecánica en una unidad de cuidados intensivos. Rev Cub Med Int Emerg. 2016;15 (2):63-68 Disponible en: http://new.medigraphic.com/cgi-bin/resumen.cgi?IDARTICULO=64920

  29. Azevedo LC, Park M, Salluh JI, Rea-Neto A, Souza-Dantas VC, Varaschin P, et al. Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care[Internet]. 2013[citado 6 Feb 2014]; 17(2):R63. Disponible en: https://ccforum.biomedcentral.com/articles/10.1186/cc12594

  30. Santos RS, Silva PL, Pelosi P, Rocco P. Recruitment maneuvers in acute respiratory distress syndrome: The safe way is the best way. World J Crit Care Med. 2015; 4; 4(4): 278-286 Disponible en: http://pubmedcentralcanada.ca/pmcc/articles/PMC4631873/

  31. Villar J, Blanco J.M, Añón A, San-tos-BouzaL, Blanch A. The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med. 2011;37: 1932-1941 Disponible en: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwicjczX9IDSAhVCbiYKHadCBjUQFggbMAA&url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%

  32. Mols G, PriebeH J, Guttmann J. Review Article. Alveolar recruitment in acute lung injury. British Journal of Anaesthesia [Internet]. 2006[citado 6 Feb 2011]; 96 (2): 156–66. Disponible en: http://bja.oxfordjournals.org/content/96/2/156.full/href

  33. Forel JM, Voillet F, Pulina D, Gaucouin A, Perrin G, Barrau K. Neumonía asociada a ventilación mecánica en pacientes con SDRA grave ventilados con estrategia protectora. Crit Care. 2012; 16: R65. Disponible en: http://ccforum.biomedcentral.com/articles/10.1186/cc11312

  34. Monge MI, Gil A, Gracia M, Díaz JC. Cambios respiratorios y hemodinámicos durante una maniobra de reclutamiento pulmonar mediante incrementos y decrementos progresivos de PEEP. Med Int [Internet]. 2012[citado 6 Feb 2013]; 36(2):77-88. Disponible en: http://www.sciencedirect.com/science/article/pii/S0210569111002555

  35. Das A, Cole O, Chikhani M, Wang W, Ali T, Haque M, et al. Evaluation of lung recruitment maneuvers in acute respiratory distress syndrome using computer simulation. Critical Care [Internet]. 2015[citado 7 Oct 2015]: [aprox. 9 p.]. Disponible en: https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0723-6

  36. Cavalcanti, AB, Suzumura EA, Abreu M, Ribeiro GF, Kodama A, MoreiraF, et al. Alveolar Recruitment for ARDS Trial: preliminary results. Crit Care [Internet]. 2013[citado 6 Feb 2014]; 17(Suppl 2):109. Disponible en: https://ccforum.biomedcentral.com/articles/10.1186/cc12047

  37. Rzezinski AF, Oliveira GP, Santiago VR, Santos RS, Ornellas DS, Mo-rales MM, et at. Prolonged recruitment maneuver improves lung function with less ultrastructural damage in experimental mild acute lung injury. Respir Physiol Neurobiol [Internet]. 2009[citado 6 Feb 2011]; 169(3):271-81. Disponible en: http://www.sciencedirect.com/scien




2020     |     www.medigraphic.com