Influência da hipertensão intra-abdominal na mecânica respiratória de pacientes adultos gravemente enfermos com ventilação mecânica invasiva
DOI:
https://doi.org/10.31053/1853.0605.v77.n4.28148Palavras-chave:
hipertensão intra-abdominal, respiração artificial, mecânica respiratória, unidades de terapia intensivaResumo
Objetivo: descrever as modificações na mecânica respiratória, as estratégias ventilatórias propostas e o posicionamento correto de pacientes adultos críticos com AIH e SCA com necessidade de VMI na UTI.
Fontes de dados: a pesquisa bibliográfica foi realizada na Pubmed, Cochrane Library e Google Scholar® sem restrição de idioma com data de publicação até 31 de julho de 2019.
Seleção do estudo: pacientes adultos com necessidade de VMI e diagnóstico de HIA e / ou SCA que realizaram a monitoração ventilatória e análise de posicionamento do paciente. Estudos de laboratório em animais serão excluídos.
Extração de dados: a busca inicial identificou 681 estudos, dos quais 30 artigos foram incluídos para análise dos dados.
Síntese dos dados: os pacientes com necessidade de VMI devem ter permissão para aumentar a pressão nas vias aéreas e o uso de PEEP alto; Somente em casos específicos, o recrutamento e as manobras propensas podem ser aplicados para manter ventilação alveolar adequada. O posicionamento invertido de Trendelemburg é útil, pois melhora a mecânica respiratória e evita a compressão abdominal.
Conclusões: alterações na mecânica respiratória produzem diminuição da complacência torácica, volumes pulmonares e distúrbios da oxigenação. A estratégia ventilatória deve considerar Vt entre 6-8 ml / kg de acordo com o peso corporal previsto, pressão de trabalho menor que 14 cm H2O, pressão de platô de 30 cm H2O + PIA / 2 e níveis suficientes de PEEP para evitar colapso pulmonar, a fim de expiração.
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