Efecto de una maniobra de reclutamiento alveolar sobre la gasometría arterial y la mecánica respiratoria en pacientes con ventilación mecánica en la unidad de cuidados intensivos

Abstract. Objective: To evaluate the effect of an alveolar recruitment maneuver with stepped PEEP titration on the gas exchange rate PaO2/FiO2) in patients with mechanical ventilatory support in the Intensive Care Unit. Population: A total of 6 patients were included in the period from March 1 to November 30, 2019. 5 men (83.3%) with a mean age of 65 years (SD 7.92), with a main diagnosis of post-resuscitation status. (n = 2), Myasthenia Gravis (n = 1), chronic renal failure (n = 1), seizure status (n = 2). Methodology: A single group pretest-posttest study was performed. Informed consent was applied to the included patients. The quantitative variables were presented as means, medians and standard deviations or interquartile ranges, and the comparisons between the different times were made using the repeated measures analysis of variance test (ANOVA). Measurements and results: Adult patients over 18 years hospitalized in the ICU diagnosed with atelectasis of the lung will be included. Patients were assigned to perform an MRA and monitor its effect by prospectively recording arterial blood gas, respiratory mechanics of the respiratory system, gas exchange rates, ventilatory parameters, and vital signs at times: T0: Baseline time (immediately before the start of the maneuver), T1: End of the MRA and PEEP titration and T2: 60 minutes after the end of the MRA and PEEP titration. The PaFiO2 ratio increased slightly in T1 and this increase was maintained until T2, the value of Vd / Vte on average shows a slight decrease of 3% when comparing T0 and T2 in groups, the Crs increased 34 ml / cmH2O gradually from T0 to T2 and the PIP and Pplat show that there were no changes in T1, but they did decrease slightly in T2. No statistically significant difference was found when performing the verification test in any of the variables evaluated in the studies. Conclusions: There is no statistically significant improvement after a stepped alveolar recruitment maneuver followed by the PEEP titration, there is the possibility that it could have a slight positive effect on the gasometric and respiratory mechanics variables, depending, both, on the magnitude of the imbalance. in the V / Q ratio, as the supposed reduction of it (atelectasis). Key Words: Alveolar recruitment, Alveolar recruitment maneuver, PEEP titration.

• Autores: González Reyes, Daniel Felipe
• Tipo de recurso: Work document
• Fecha de publicación: 2019
• Institución: Universidad Nacional de Colombia
• Repositorio: Universidad Nacional de Colombia
• Idioma: spa
• OAI Identifier: oai:repositorio.unal.edu.co:unal/77837
• Acceso en línea: https://repositorio.unal.edu.co/handle/unal/77837
• Palabra clave: 610 - Medicina y salud, 612 - Fisiología humana; Reclutamiento alveolar; Maniobra de reclutamiento alveolar; Titulación de PEEP; Alveolar recruitment; Alveolar recruitment maneuver; PEEP titration
• Rights: openAccess
• License: Atribución-SinDerivadas 4.0 Internacional