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 No...
- 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
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- openAccess
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- Atribución-SinDerivadas 4.0 Internacional
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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 |
| title |
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 |
| spellingShingle |
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 610 - Medicina y salud, 612 - Fisiología humana Reclutamiento alveolar Maniobra de reclutamiento alveolar Titulación de PEEP Alveolar recruitment Alveolar recruitment maneuver PEEP titration |
| title_short |
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 |
| title_full |
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 |
| title_fullStr |
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 |
| title_full_unstemmed |
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 |
| title_sort |
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 |
| dc.creator.fl_str_mv |
González Reyes, Daniel Felipe |
| dc.contributor.advisor.spa.fl_str_mv |
Diaztagle Fernández, Juan José |
| dc.contributor.author.spa.fl_str_mv |
González Reyes, Daniel Felipe |
| dc.subject.ddc.spa.fl_str_mv |
610 - Medicina y salud, 612 - Fisiología humana |
| topic |
610 - Medicina y salud, 612 - Fisiología humana Reclutamiento alveolar Maniobra de reclutamiento alveolar Titulación de PEEP Alveolar recruitment Alveolar recruitment maneuver PEEP titration |
| dc.subject.proposal.spa.fl_str_mv |
Reclutamiento alveolar Maniobra de reclutamiento alveolar Titulación de PEEP |
| dc.subject.proposal.eng.fl_str_mv |
Alveolar recruitment Alveolar recruitment maneuver PEEP titration |
| description |
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. |
| publishDate |
2019 |
| dc.date.issued.spa.fl_str_mv |
2019-07-09 |
| dc.date.accessioned.spa.fl_str_mv |
2020-07-24T03:27:56Z |
| dc.date.available.spa.fl_str_mv |
2020-07-24T03:27:56Z |
| dc.type.spa.fl_str_mv |
Documento de trabajo |
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info:eu-repo/semantics/workingPaper |
| dc.type.version.spa.fl_str_mv |
info:eu-repo/semantics/acceptedVersion |
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http://purl.org/coar/resource_type/c_8042 |
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http://purl.org/redcol/resource_type/WP |
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https://repositorio.unal.edu.co/handle/unal/77837 |
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https://repositorio.unal.edu.co/handle/unal/77837 |
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spa |
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spa |
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Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Biehl M, Binnekade JM, et al. Protective versus Conventional Ventilation for SurgeryA Systematic Review and Individual Patient Data Meta-analysis. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2015;123(1):66-78. 67. Richard J-C, Maggiore SM, Jonson B, Mancebo J, Lemaire F, Brochard L. Influence of tidal volume on alveolar recruitment: respective role of PEEP and a recruitment maneuver. American journal of respiratory and critical care medicine. 2001;163(7):1609-13. 68. Borsellino B, Schultz MJ, Gama de Abreu M, Robba C, Bilotta F. Mechanical ventilation in neurocritical care patients: a systematic literature review. Expert review of respiratory medicine. 2016;10(10):1123-32. 69. Klingstedt C, Hedenstierna G, Lundquist H, Strandberg A, Tgkics L, Brismar B. The influence of body position and differential ventilation on lung dimensions and atelectasis formation in anaesthetized man. 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The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesthesia & Analgesia. 2006;102(1):298-305. 81. Cavalcanti AB, Suzumura ÉA, Laranjeira LN, de Moraes Paisani D, Damiani LP, Guimarães HP, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. Jama. 2017;318(14):1335-45. 82. Mancebo J, Mercat A, Brochard L. Maximal Lung Recruitment in ARDS: A Nail in the Coffin. American journal of respiratory and critical care medicine. 2019(ja). 83. Chen L, Del Sorbo L, Grieco DL, Junhasavasdikul D, Rittayamai N, Soliman I, et al. Potential for Lung Recruitment Estimated by the Recruitment-to-Inflation Ratio in Acute Respiratory Distress Syndrome. American Journal of Respiratory and Critical Care Medicine. 2019(ja). |
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Derechos reservados - Universidad Nacional de Colombia |
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Atribución-SinDerivadas 4.0 InternacionalDerechos reservados - Universidad Nacional de ColombiaAcceso abiertohttp://creativecommons.org/licenses/by-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Diaztagle Fernández, Juan Joséa385b77d-361e-4eea-902f-51a9d3eec899-1González Reyes, Daniel Felipe8c733eaa-e85f-4a79-9a24-f1e7885a9ee02020-07-24T03:27:56Z2020-07-24T03:27:56Z2019-07-09https://repositorio.unal.edu.co/handle/unal/77837Abstract. 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.Objetivo: Evaluar el efecto de una maniobra de reclutamiento alveolar con titulación escalonada de PEEP sobre el índice de intercambio gaseoso PaO2/FiO2) en pacientes con soporte ventilatorio mecánico en la Unidad de Cuidados Intensivos. Población: En total 6 pacientes fueron incluidos entre el período comprendido entre el 1 de marzo a 30 de noviembre de 2019. 5 hombres (83.3%) con media de edad de 65 años (DE 7.92), con diagnóstico principal de estado post-reanimación (n=2), Miastenia Gravis (n=1), insuficiencia renal crónica (n=1), status convulsivo (n=2). Metodología: Se realizó un estudio pretest-postest de un solo grupo. Se aplicó consentimiento informado a los pacientes incluidos. Las variables cuantitativas se presentaron en medias, medianas y desviaciones estándar o rangos intercuartílicos y las comparaciones entre los diferentes tiempos se realizaron por medio de la prueba de análisis de varianza de medidas repetidas (ANOVA). Mediciones y resultados: Se incluirán pacientes adultos mayores de 18 años hospitalizados en la UCI diagnosticados con atelectasia pulmonar. Los pacientes fueron asignados a la realización de una MRA y monitorización de su efecto por medio del registro prospectivo de la gasometría arterial, mecánica ventilatoria del sistema respiratorio, índices de intercambio gaseoso, parámetros ventilatorios y signos vitales en los tiempos: T0: Tiempo basal (inmediatamente antes del inicio de la maniobra), T1: Final de la MRA y titulación de PEEP y T2: 60 minutos después de la finalización de MRA y titulación de PEEP. La relación PaFiO2 aumento de forma leve en el T1 y este aumento se mantuvo hasta el T2, el valor de Vd/Vte en promedio se evidencia una discreta disminución de 3% cuando se compara el T0 y T2 de forma grupal, la Crs aumento 34 ml/cmH2O de forma gradual de T0 a T2 y la PIP y Pplat, muestran que no hubo cambios en T1, pero si disminuyeron levemente en T2. No se encontró diferencia estadísticamente significativa al realizar el test de comprobación en ninguna de las variables evaluadas en el estudios . Conclusiones: No existe una mejoría estadísticamente significativa tras una maniobra de reclutamiento alveolar escalonada seguida de la titulación de PEEP, existe la posibilidad que podría tener un leve efecto positivo en las variables gasométricas y de mecánica respiratoria que dependerá, tanto, de la magnitud del desequilibrio en la relación V/Q, como la supuesta reducción del mismo (atelectasia). Palabras Claves: Reclutamiento alveolar, Maniobra de reclutamiento alveolar, Titulación de PEEP.Magíster en Fisiología. Fisiología Aplicada al Cuidado Crítico.Maestría81application/pdfspa610 - Medicina y salud, 612 - Fisiología humanaReclutamiento alveolarManiobra de reclutamiento alveolarTitulación de PEEPAlveolar recruitmentAlveolar recruitment maneuverPEEP titrationEfecto de una maniobra de reclutamiento alveolar sobre la gasometría arterial y la mecánica respiratoria en pacientes con ventilación mecánica en la unidad de cuidados intensivosDocumento de trabajoinfo:eu-repo/semantics/workingPaperinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/coar/resource_type/c_8042Texthttp://purl.org/redcol/resource_type/WPBogotá - Medicina - Maestría en FisiologíaUniversidad Nacional de Colombia - Sede Bogotá1. Klompas M, Khan Y, Kleinman K, Evans RS, Lloyd JF, Stevenson K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. 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