Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisis

Los pacientes pediátricos sometidos a anestesia general corren el riesgo de desarrollar complicaciones pulmonares postoperatorias y, una proporción significativa adquirirá algún grado de lesión pulmonar aguda. El reclutamiento pulmonar es una estrategia que permite contrarrestar el desreclutamiento...

Full description

Autores:
Montoya Ruiz, María Camila
Tipo de recurso:
https://purl.org/coar/resource_type/c_7a1f
Fecha de publicación:
2024
Institución:
Universidad El Bosque
Repositorio:
Repositorio U. El Bosque
Idioma:
spa
OAI Identifier:
oai:repositorio.unbosque.edu.co:20.500.12495/12763
Acceso en línea:
https://hdl.handle.net/20.500.12495/12763
Palabra clave:
Reclutamiento pulmonar
Atelectasias
Distensibilidad pulmonar
Desaturación
Anestesia general
Ventilación mecánica
Lung recruitment
Atelectasis
Pulmonary compliance
Desaturation
General anesthesia
Mechanical ventilation
WO 200
Rights
openAccess
License
Atribución-NoComercial-CompartirIgual 4.0 Internacional
id UNBOSQUE2_dcec5488cdefe5b71d3efb7220154374
oai_identifier_str oai:repositorio.unbosque.edu.co:20.500.12495/12763
network_acronym_str UNBOSQUE2
network_name_str Repositorio U. El Bosque
repository_id_str
dc.title.none.fl_str_mv Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisis
dc.title.translated.none.fl_str_mv Efficacy and safety of lung recruitment maneuvers in pediatric population without pulmonary pathology: a systematic review and meta-analysis
title Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisis
spellingShingle Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisis
Reclutamiento pulmonar
Atelectasias
Distensibilidad pulmonar
Desaturación
Anestesia general
Ventilación mecánica
Lung recruitment
Atelectasis
Pulmonary compliance
Desaturation
General anesthesia
Mechanical ventilation
WO 200
title_short Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisis
title_full Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisis
title_fullStr Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisis
title_full_unstemmed Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisis
title_sort Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisis
dc.creator.fl_str_mv Montoya Ruiz, María Camila
dc.contributor.advisor.none.fl_str_mv Guillermo , Madrid
Mendoza O´Byrne, Mario
dc.contributor.author.none.fl_str_mv Montoya Ruiz, María Camila
dc.subject.none.fl_str_mv Reclutamiento pulmonar
Atelectasias
Distensibilidad pulmonar
Desaturación
Anestesia general
Ventilación mecánica
topic Reclutamiento pulmonar
Atelectasias
Distensibilidad pulmonar
Desaturación
Anestesia general
Ventilación mecánica
Lung recruitment
Atelectasis
Pulmonary compliance
Desaturation
General anesthesia
Mechanical ventilation
WO 200
dc.subject.keywords.none.fl_str_mv Lung recruitment
Atelectasis
Pulmonary compliance
Desaturation
General anesthesia
Mechanical ventilation
dc.subject.nlm.none.fl_str_mv WO 200
description Los pacientes pediátricos sometidos a anestesia general corren el riesgo de desarrollar complicaciones pulmonares postoperatorias y, una proporción significativa adquirirá algún grado de lesión pulmonar aguda. El reclutamiento pulmonar es una estrategia que permite contrarrestar el desreclutamiento alveolar crónico que ocurre como resultado a los bajos volúmenes corriente. Por lo tanto, el objetivo principal de las maniobras de reclutamiento pulmonar es reducir la aparición de atelectasias, minimizando el área pulmonar no disponible. Evaluar la eficacia y seguridad de las maniobras de reclutamiento pulmonar sobre las atelectasias en pacientes pediátricos bajo anestesia general. Metodología: Se realizó una revisión sistemática y metaanálisis. Métodos de búsqueda: se identificaron ensayos clínicos con asignación aleatoria en el PubMed, Web of Science, Scopus, Cochrane Library y LILACS, hasta diciembre de 2021 sin restricciones en el idioma de publicación. Criterios de selección: ensayos clínicos controlados aleatorios que compararon las maniobras de reclutamiento pulmonar versus placebo en niños pulmonarmente sanos llevados a cirugía bajo anestesia general. El desenlace primario fue la incidencia de atelectasias postoperatorias. Los desenlaces secundarios fueron desaturación, distensibilidad pulmonar y eventos adversos. Recopilación y análisis de datos: dos autores evaluaron de forma independiente la calidad de los ensayos y extrajeron los datos. Análisis de los datos: se utilizó la metodología GRADE para analizar la calidad de la evidencia. Las variables continuas y dicotómicas fueron extraídas con medias ± desviación estándar y frecuencias respectivamente. Para las variables dicotómicas se calcularon riesgos relativos (RR) con intervalos de confianza del 95% y se metaanalizaron los datos según fuera apropiado.
publishDate 2024
dc.date.accessioned.none.fl_str_mv 2024-07-30T13:55:26Z
dc.date.available.none.fl_str_mv 2024-07-30T13:55:26Z
dc.date.issued.none.fl_str_mv 2024-07
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv Tesis/Trabajo de grado - Monografía - Especialización
dc.type.coar.none.fl_str_mv https://purl.org/coar/resource_type/c_7a1f
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
dc.type.coarversion.none.fl_str_mv https://purl.org/coar/version/c_ab4af688f83e57aa
format https://purl.org/coar/resource_type/c_7a1f
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12495/12763
dc.identifier.instname.spa.fl_str_mv instname:Universidad El Bosque
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad El Bosque
dc.identifier.repourl.none.fl_str_mv repourl:https://repositorio.unbosque.edu.co
url https://hdl.handle.net/20.500.12495/12763
identifier_str_mv instname:Universidad El Bosque
reponame:Repositorio Institucional Universidad El Bosque
repourl:https://repositorio.unbosque.edu.co
dc.language.iso.fl_str_mv spa
language spa
dc.relation.references.none.fl_str_mv Kneyber MCJ. Intraoperative mechanical ventilation for the pediatric patient. Vol. 29, Best Practice and Research: Clinical Anaesthesiology. 2015.
Feldman JM. Optimal ventilation of the anesthetized pediatric patient. Vol. 120, Anesthesia and Analgesia. 2015.
Zanza C, Longhitano Y, Leo M, Romenskaya T, Franceschi F, Piccioni A, et al. Practical Review of Mechanical Ventilation in Adults and Children in the Operating Room and Emergency Department. Rev Recent Clin Trials. 2021;17(1).
Kneyber MCJ, Jouvet PA, Rimensberger PC. How to manage ventilation in pediatric acute respiratory distress syndrome? Intensive Care Med [Internet]. 2014 Nov 21 [cited 2024 Jul 1];40(12):1924–6
Dahlem P, van Aalderen WMC, Bos AP. Pediatric acute lung injury. Vol. 8, Paediatric Respiratory Reviews. 2007. p. 348–62.
Tusman G, Böhm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Vol. 25, Current Opinion in Anaesthesiology. 2012.
Martínez G, Cruz P. Atelectasias en anestesia general y estrategias de reclutamiento alveolar. Rev Esp Anestesiol Reanim [Internet]. 2008 Oct 1 [cited 2024 Jul 2];55(8):493–503
Jauncey-Cooke J, East CE, Bogossian F. Paediatric lung recruitment: A review of the clinical evidence. Vol. 16, Paediatric Respiratory Reviews. 2015.
Neto AS, Nagtzaam L, Schultz MJ. Ventilation with lower tidal volumes for critically ill patients without the acute respiratory distress syndrome: A systematic translational review and meta-Analysis. Curr Opin Crit Care. 2014 Feb;20(1):25–32.
Plötz FB, Slutsky AS, Van Vught AJ, Heijnen CJ. Ventilator-induced lung injury and multiple system organ failure: A critical review of facts and hypotheses. Vol. 30, Intensive Care Medicine. 2004.
Halbertsma FJJ, Vaneker M, Scheffer GJ, van der Hoeven JG. Cytokines and biotrauma in ventilator-induced lung injury: A critical review of the literature. Vol. 63, Netherlands Journal of Medicine. 2005.
Boriosi JP, Sapru A, Hanson JH, Asselin J, Gildengorin G, Newman V, et al. Efficacy and safety of lung recruitment in pediatric patients with acute lung injury. Pediatric Critical Care Medicine. 2011;12(4).
Wolthuis EK, Choi G, Dessing MC, Bresser P, Lutter R, Dzoljic M, et al. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology. 2008;108(1).
Cui Y, Cao R, Li G, Gong T, Ou Y, Huang J. The effect of lung recruitment maneuvers on post-operative pulmonary complications for patients undergoing general anesthesia: A meta-analysis. PLoS One. 2019;14(5).
Goligher EC, Hodgson CL, Adhikari NKJ, Meade MO, Wunsch H, Uleryk E, et al. Lung recruitment maneuvers for adult patients with acute respiratory distress syndrome: A systematic review and meta-analysis. Vol. 14, Annals of the American Thoracic Society. 2017.
Kheir JN, Walsh BK, Smallwood CD, Rettig JS, Thompson JE, Gómez-Laberge C, et al. Comparison of 2 lung recruitment strategies in children with acute lung injury. Respir Care. 2013;58(8).
Song IK, Kim EH, Lee JH, Ro S, Kim HS, Kim JT. Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial. Anaesthesia. 2017;72(2).
Acosta CM, Sara T, Carpinella M, Volpicelli G, Ricci L, Poliotto S, et al. Lung recruitment prevents collapse during laparoscopy in children. Eur J Anaesthesiol. 2018;35(8).
Duff JP, Rosychuk RJ, Joffe AR. The safety and efficacy of sustained inflations as a lung recruitment maneuver in pediatric intensive care unit patients. Intensive Care Med. 2007;33(10).
Bruins S, Sommerfield D, Powers N, von Ungern-Sternberg BS. Atelectasis and lung recruitment in pediatric anesthesia: An educational review. Vol. 32, Paediatric Anaesthesia. 2022.
He P, Wu C, Yang Y, Zheng J, Dong W, Wu J, et al. Effectiveness of postural lung recruitment on postoperative atelectasis assessed by lung ultrasound in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass. Pediatr Pulmonol. 2021;56(6).
Gordo Vidal F, Delgado Arnaiz C, Calvo Herranz E. Lesión pulmonar inducida por la ventilación mecánica*. Med Intensiva [Internet]. 2007 Jan 1 [cited 2024 Jul 1];31(1):18–26.
Parker JC, Hernandez LA, Peevy KJ. Mechanisms of ventilator-induced lung injury. Crit Care Med. 1993;21(1).
Slutsky AS, Ranieri VM. Ventilator-Induced Lung Injury. New England Journal of Medicine [Internet]. 2013 Nov 28 [cited 2024 Jul 1];369(22):2126–36.
Bendixen HH, Whyte H, Laver MB. Impaired Oxygenation in Surgical Patients during General Anesthesia with Controlled Ventilation. New England Journal of Medicine. 1963;269(19).
Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Ruiz RM, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surg. 2017;152(2).
Neto AS, Hemmes SNT, Barbas CSV, Beiderlinden M, Fernandez-Bustamante A, Futier E, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: A systematic review and meta-analysis. Lancet Respir Med. 2014;2(12).
Mietto C, Pinciroli R, Patel N, Berra L. Ventilator associated pneumonia: Evolving definitions and preventive strategies. Respir Care. 2013;58(6).
Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: Review and meta-analysis. Vol. 18, Critical Care. 2014.
De Prost N, Dreyfuss D. How to prevent ventilator-induced lung injury? Vol. 78, Minerva Anestesiologica. 2012.
Pelosi P, Negrini D. Extracellular matrix and mechanical ventilation in healthy lungs: Back to baro/volotrauma? Vol. 14, Current Opinion in Critical Care. 2008.
Leme Silva P, Scharffenberg M, Rieken Macedo Rocco P. Understanding the mechanisms of ventilator-induced lung injury using animal models. Intensive Care Med Exp [Internet]. 2023 [cited 2024 Jul 1];11:82.
Wilson MR, Choudhury S, Goddard ME, O’Dea KP, Nicholson AG, Takata M. High tidal volume upregulates intrapulmonary cytokines in an in vivo mouse model of ventilator-induced lung injury. J Appl Physiol. 2003;95(4).
Lionetti V, Recchia FA, Ranieri VM. Overview of ventilator-induced lung injury mechanisms. Vol. 11, Current Opinion in Critical Care. 2005.
Webb HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end expiratory pressure. AMERREVRESPDIS. 1974;110(5).
Kolobow T, Moretti MP, Fumagalli R, Mascheroni D, Prato P, Chen V, et al. Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study. American Review of Respiratory Disease. 1987;135(2
John E, Ermocilla R, Golden J, McDevitt M, Cassady G. Effects of intermittent positive-pressure ventilation of lungs of normal rabbits. Br J Exp Pathol. 1980;61(3).
Goodman RB, Strieter RM, Martin DP, Steinberg KP, Milberg JA, Maunder RJ, et al. Inflammatory cytokines in patients with persistence of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1996;154(3 I).
Chollet-Martin S, Jourdain B, Gibert C, Elbim C, Chastre J, Cougerot-Pocidalo MA. Interactions between neutrophils and cytokines in blood and alveolar spaces during ARDS. Am J Respir Crit Care Med. 1996;154(3 I).
Colmenero-Ruiz M, Fernández-Mondéjar E, Fernández-Sacristán MA, Rivera-Fernández R, Vazquez-Mata G. PEEP and low tidal volume ventilation reduce lung water in porcine pulmonary edema. Am J Respir Crit Care Med. 1997;155(3).
Duggan M, Kavanagh BP. Pulmonary AtelectasisA Pathogenic Perioperative Entity. Anesthesiology [Internet]. 2005 Apr 1 [cited 2024 Jul 3];102(4):838–54.
Gajic O, Dara SI, Mendez JL, Adesanya AO, Festic E, Caples SM, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Vol. 32, Critical Care Medicine. 2004.
Pinhu L, Whitehead T, Evans T, Griffiths M. Ventilator-associated lung injury. Lancet [Internet]. 2003 Jan 25 [cited 2024 Jul 7];361(9354):332–40.
Coppola S, Froio S, Chiumello D. Protective lung ventilation during general anesthesia: Is there any evidence? Crit Care [Internet]. 2014 Mar 18 [cited 2024 Jul 2];18(2):1–7.
Cai H, Gong H, Zhang L, Wang Y, Tian Y. Effect of low tidal volume ventilation on atelectasis in patients during general anesthesia: a computed tomographic scan. J Clin Anesth. 2007;19(2).
Duggan M, Kavanagh BP. Pulmonary atelectasis: A pathogenic perioperative entity. Vol. 102, Anesthesiology. 2005.
Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L. Pulmonary densities during anesthesia with muscular relaxation - A proposal of atelectasis. Anesthesiology. 1985;62(4).
Hedenstierna G, Rothen HU. Atelectasis formation during anesthesia: Causes and measures to prevent it. Vol. 16, Journal of Clinical Monitoring and Computing. 2000.
Woo SW, Berlin D, Hedley-Whyte J. Surfactant function and anesthetic agents. J Appl Physiol. 1969;26(5).
Tobin WR, Kaiser HE, Groeger AM, Lema MJ. The effects of volatile anesthetic agents on pulmonary surfactant function. Vol. 14, In Vivo. 2000.
Otis DR, Johnson M, Pedley TJ, Kamm RD. Role of pulmonary surfactant in airway closure: A computational study. J Appl Physiol. 1993;75(3).
Nguyen T kien, Mai DH, Le AN, Nguyen QH, Nguyen CT, Vu TA. A review of intraoperative lung-protective mechanical ventilation strategy. Vol. 37, Trends in Anaesthesia and Critical Care. 2021.
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. New England Journal of Medicine. 2013;369(5).
Wrigge H, Zinserling J, Stuber F, Von Spiegel T, Hering R, Wetegrove S, et al. Effects of mechanical ventilation on release of cytokines into systemic circulation in patients with normal pulmonary function. Anesthesiology. 2000;93(6).
Wrigge H, Uhlig U, Zinserling J, Behrends-Callsen E, Ottersbach G, Fischer M, et al. The Effects of Different Ventilatory Settings on Pulmonary and Systemic Inflammatory Responses during Major Surgery. Anesth Analg. 2004;98(3).
Severgnini P, Selmo G, Lanza C, Chiesa A, Frigerio A, Bacuzzi A, et al. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology. 2013;118(6).
Hemmes SNT, Severgnini P, Jaber S, Canet J, Wrigge H, Hiesmayr M, et al. Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery. Trials. 2011;12.
Jaber S, Coisel Y, Chanques G, Futier E, Constantin JM, Michelet P, et al. A multicentre observational study of intra-operative ventilatory management during general anaesthesia: Tidal volumes and relation to body weight. Anaesthesia. 2012;67(9).
Hess DR, Kondili D, Burns E, Bittner EA, Schmidt UH. A 5-year observational study of lung-protective ventilation in the operating room: A single-center experience. J Crit Care. 2013 Aug 1;28(4):533.e9-533.e15.
Moriondo A, Marcozzi C, Bianchin F, Reguzzoni M, Severgnini P, Protasoni M, et al. Impact of mechanical ventilation and fluid load on pulmonary glycosaminoglycans. Respir Physiol Neurobiol [Internet]. 2012 May 31 [cited 2024 Jul 7];181(3):308–20.
Wolthuis EK, Vlaar APJ, Choi G, Roelofs JJTH, Juffermans NP, Schultz MJ. Mechanical ventilation using non-injurious ventilation settings causes lung injury in the absence of pre-existing lung injury in healthy mice. Crit Care [Internet]. 2009 [cited 2024 Jul 7];13(1).
Zupancich E, Paparella D, Turani F, Munch C, Rossi A, Massaccesi S, et al. Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery: A randomized clinical trial. Journal of Thoracic and Cardiovascular Surgery [Internet]. 2005 Aug [cited 2024 Jul 7];130(2):378–83.
Schilling T, Kozian A, Huth C, Bühling F, Kretzschmar M, Welte T, et al. The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery. Anesth Analg [Internet]. 2005 [cited 2024 Jul 7];101(4):957–65.
Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6).
Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: Patient safety summit on definition, risk-reducing interventions, and preventive strategies. Vol. 39, Critical Care Medicine. 2011.
Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997;111(3).
Brooks-Brunn JA. Postoperative atelectasis and pneumonia: risk factors. Vol. 4, American journal of critical care : an official publication, American Association of Critical-Care Nurses. 1995.
Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg. 2000;232(2).
Ferreyra GP, Baussano I, Squadrone V, Richiardi L, Marchiaro G, Del Sorbo L, et al. Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: A systematic review and meta-analysis. Ann Surg. 2008;247(4).
Lusquinhos J, Tavares M, Abelha F. Postoperative Pulmonary Complications and Perioperative Strategies: A Systematic Review. 2023;
Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med [Internet]. 2011 Jun [cited 2024 Jul 7];37(6):918–29.
Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6).
Sigona A, Richman DC. Identifying and reducing risks of postoperative pulmonary complications. Journal of Oral and Maxillofacial Anesthesia [Internet]. 2023 Dec 30 [cited 2024 Jul 7];2(0):30–30.
Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: A 7 day cohort study. The Lancet. 2012;380(9847).
Tsumura H, Harris E, Brandon D, Pan W, Vacchiano C. Review of the Mechanisms of Ventilator Induced Lung Injury and the Principles of Intraoperative Lung Protective Ventilation. AANA J. 2021;89(3).
Park SJ, Kim BG, Oh AH, Han SH, Han HS, Ryu JH. Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial. Surg Endosc [Internet]. 2016 Oct 1 [cited 2024 Jul 7];30(10):4598–606.
Lagier D, Zeng C, Fernandez-Bustamante A, Vidal Melo MF. Perioperative Pulmonary Atelectasis: Part II. Clinical Implications. Vol. 136, Anesthesiology. 2022.
Kelkar KV. Post-operative pulmonary complications after non-cardiothoracic surgery. Indian J Anaesth [Internet]. 2015 Sep 1 [cited 2024 Jul 8];59(9):599.
Poelaert J, Szegedi L, Blot S. Prevention of Postoperative Pulmonary Problems Starts Intraoperatively. Annual Update in Intensive Care and Emergency Medicine 2013 [Internet]. 2013 [cited 2024 Jul 8];539–52.
Tokics L, Hedenstierna G, Strandberg A, Brismar B, Lundquist H. Lung collapse and gas exchange during general anesthesia: Effects of spontaneous breathing, muscle paralysis, and positive end-expiratory pressure. Anesthesiology. 1987;66(2).
Magnusson L. New concepts of atelectasis during general anaesthesia. Br J Anaesth. 2003;91(1).
Ty C, Eva C, Chan YF. Postoperative pulmonary complications and their prevention.
Ko E, Yoo KY, Lim CH, Jun S, Lee K, Kim YH. Is atelectasis related to the development of postoperative pneumonia? a retrospective single center study. BMC Anesthesiol. 2023;23(1).
Saikia D, Mahanta B. Cardiovascular and respiratory physiology in children. Indian J Anaesth [Internet]. 2019 Sep 1 [cited 2024 Jul 8];63(9):690.
Gonzalez LP, Pignaton W, Kusano PS, Módolo NSP, Braz JRC, Braz LG. Anesthesia-related mortality in pediatric patients: A systematic review. Vol. 67, Clinics. 2012.
Tay CLM, Tan GM, Ng SBA. Critical incidents in paediatric anaesthesia: An audit of 10 000 anaesthetics in Singapore. Paediatr Anaesth. 2001;11(6).
Gerhardt T, Hehre D, Feller R, Reifenberg L, Bancalari E. Pulmonary mechanics in normal infants and young children during first 5 years of life. Pediatr Pulmonol. 1987;3(5).
Lanteri CJ, Sly PD. Changes in respiratory mechanics with age. J Appl Physiol. 1993;74(1).
Narayanan M, Owers-Bradley J, Beardsmore CS, Mada M, Ball I, Garipov R, et al. Alveolarization continues during childhood and adolescence: New evidence from helium-3 magnetic resonance. Am J Respir Crit Care Med. 2012;185(2).
Tepper RS, Williams T, Kisling J, Castile R. Static compliance of the respiratory system in healthy infants. Am J Respir Crit Care Med. 2001;163(1).
Dunnill MS. The problem of lung growth. Vol. 37, Thorax. 1982.
Papastamelos C, Panitch HB, England SE, Allen JL. Developmental changes in chest wall compliance in infancy and early childhood. J Appl Physiol. 1995;78(1).
Santschi M, Randolph AG, Rimensberger PC, Jouvet P. Mechanical ventilation strategies in children with acute lung injury: A survey on stated practice pattern. Pediatric Critical Care Medicine. 2013;14(7).
Randolph AG. Management of acute lung injury and acute respiratory distress syndrome in children. Crit Care Med [Internet]. 2009 [cited 2024 Jul 9];37(8):2448–54.
Plötz FB, Vreugdenhil HA, Slutsky AS, Zijlstra J, Heijnen CJ, Van Vught H. Mechanical ventilation alters the immune response in children without lung pathology. Intensive Care Med. 2002;28(4).
Kneyber MCJ, Zhang H, Slutsky AS. Ventilator-induced lung injury: Similarity and differences between children and adults. Vol. 190, American Journal of Respiratory and Critical Care Medicine. 2014.
Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, et al. Acute lung injury in pediatric intensive care in Australia and New Zealand - A prospective, multicenter, observational study. Pediatric Critical Care Medicine. 2007;8(4).
Khemani RG, Conti D, Alonzo TA, Bart RD, Newth CJL. Effect of tidal volume in children with acute hypoxemic respiratory failure. Intensive Care Med. 2009;35(8).
Kneyber MCJ, Rimensberger PC. The need for and feasibility of a pediatric ventilation trial: Reflections on a survey among pediatric intensivists. Vol. 13, Pediatric Critical Care Medicine. 2012.
Bachiller PR, McDonough JM, Feldman JM. Do new anesthesia ventilators deliver small tidal volumes accurately during volume-controlled ventilation? Anesth Analg. 2008;106(5).
Ingaramo OA, Ngo T, Khemani RG, Newth CJL. Impact of positive end-expiratory pressure on cardiac index measured by ultrasound cardiac output monitor. Pediatric Critical Care Medicine. 2014;15(1).
Güldner A, Kiss T, Serpa Neto A, Hemmes SNT, Canet J, Spieth PM, et al. Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications. Anesthesiology. 2015;123(3).
Tao T, Bo L, Chen F, Xie Q, Zou Y, Hu B, et al. Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: A meta-analysis of randomised controlled trials. BMJ Open. 2014;4(6).
O’Gara B, Talmor D. Perioperative lung protective ventilation. Vol. 362, BMJ (Clinical research ed.). 2018.
Arango-Granados MC, Ariza F. Ventilación protectora y maniobras de reclutamiento pulmonar en cirugía mayor. Revista Argentina de Anestesiología. 2016;74(1).
Hedenstierna G, Tenling A. The lung during and after thoracic anaesthesia. Vol. 18, Current Opinion in Anaesthesiology. 2005.
Serpa Neto A, Hemmes SNT, Barbas CS V, Beiderlinden M, Biehl M, Binnekade JM, et al. Protective versus Conventional Ventilation for Surgery. Anesthesiology. 2015;123(1).
Lovas A, Szakmány T. Haemodynamic Effects of Lung Recruitment Manoeuvres. Vol. 2015, BioMed Research International. 2015.
Garnero A, Tuxen D, Corno G, Durand-Gasselin J, Hodgson C, Arnal JM. Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients. Crit Care. 2015;19(1).
Xia F, Pan C, Wang L, Liu L, Liu S, Guo F, et al. Physiological effects of different recruitment maneuvers in a pig model of ARDS. BMC Anesthesiol. 2020;20(1).
Devor R, Bassi H, Kang P, Morandi T, Richardson K, Nigro J, et al. Safety and efficacy of lung recruitment maneuvers in pediatric post-operative cardiac patients. Southwest J Pulm Crit Care. 2020 Jan 10;20(1):16–28.
Bhalla AK, Khemani R. Recruitment maneuvers to the extreme. Vol. 61, Respiratory Care. 2016.
Pelosi P, de Abreu MG, Rocco PRM. New and conventional strategies for lung recruitment in acute respiratory distress syndrome. Vol. 14, Critical Care. 2010.
Rabbitts JA, Groenewald CB. Epidemiology of Pediatric Surgery in the United States.
Jang YE, Ji SH, Kim EH, Lee JH, Kim JT, Kim HS. Effect of regular alveolar recruitment on intraoperative atelectasis in paediatric patients ventilated in the prone position: a randomised controlled trial. Br J Anaesth. 2020;124(5).
Amato MBP, Valente Barbas CS, Medeiros DM, Magaldi RB, De Pinto Schettino G, Lorenzi-Filho G, et al. Effect of a protective ventilation strategy on mortality in the acute respiratory distress syndrome. Pneumologie. 1998;52(5).
O’Gara B, Talmor D. Lung protective properties of the volatile anesthetics. Intensive Care Med. 2016;42(9).
Jabaudon M, Futier E, Roszyk L, Sapin V, Pereira B, Constantin JM. Association between intraoperative ventilator settings and plasma levels of soluble receptor for advanced glycation end-products in patients without pre-existing lung injury. Respirology. 2015;20(7).
Lundquist H, Hedenstierna G, Strandberg, Tokics L, Brismar B. CT-assessment of dependent lung densities in man during general anaesthesia. Acta radiol. 1995;36(4–6).
Hess DR. Recruitment Maneuvers and PEEP Titration. Respir Care [Internet]. 2015 Nov 1 [cited 2024 Jul 10];60(11):1688–704.
Egbert LD, Laver MB, Bendixen HH. Intermittent Deep Breaths and Compliance During Anesthesia in Man. Anesthesiology. 1963;24(1).
Reinius H, Jonsson L, Gustafsson S, Sundbom M, Duvernoy O, Pelosi P, et al. Prevention of Atelectasis in Morbidly Obese Patients during General Anesthesia and ParalysisA Computerized Tomography Study. Anesthesiology [Internet]. 2009 Nov 1 [cited 2024 Jul 10];111(5):979–87.
Futier E, Constantin JM, Pelosi P, Chanques G, Kwiatkoskwi F, Jaber S, et al. Intraoperative Recruitment Maneuver Reverses Detrimental Pneumoperitoneum-induced Respiratory Effects in Healthy Weight and Obese Patients Undergoing Laparoscopy. Anesthesiology [Internet]. 2010 Dec 1 [cited 2024 Jul 10];113(6):1310–9.
Whalen FX, Gajic O, Thompson GB, Kendrick ML, Que FL, Williams BA, et al. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg. 2006;102(1):298–305.
Choi ES, Oh AY, In CB, Ryu JH, Jeon YT, Kim HG. Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy: A randomised single-blinded trial. PLoS One [Internet]. 2017 Sep 1 [cited 2024 Jul 10];12(9).
dc.rights.en.fl_str_mv Atribución-NoComercial-CompartirIgual 4.0 Internacional
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_abf2
dc.rights.uri.none.fl_str_mv http://creativecommons.org/licenses/by-nc-sa/4.0/
dc.rights.local.spa.fl_str_mv Acceso abierto
dc.rights.accessrights.none.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv Atribución-NoComercial-CompartirIgual 4.0 Internacional
http://creativecommons.org/licenses/by-nc-sa/4.0/
Acceso abierto
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.mimetype.none.fl_str_mv application/pdf
dc.publisher.program.spa.fl_str_mv Especialización en Anestesiología
dc.publisher.grantor.spa.fl_str_mv Universidad El Bosque
dc.publisher.faculty.spa.fl_str_mv Facultad de Medicina
institution Universidad El Bosque
bitstream.url.fl_str_mv https://repositorio.unbosque.edu.co/bitstreams/5aae367a-a9c5-4834-96ca-b684beb40b0e/download
https://repositorio.unbosque.edu.co/bitstreams/577593f9-1795-4a30-8361-c5d73ad3f3ab/download
https://repositorio.unbosque.edu.co/bitstreams/9198b456-1849-4e05-8012-a7756c70ff8d/download
https://repositorio.unbosque.edu.co/bitstreams/f761f3c7-9e64-4260-ac51-a8a0c9c44ef1/download
https://repositorio.unbosque.edu.co/bitstreams/e7c92bb5-c563-4ea5-8e04-2bc0a610b838/download
https://repositorio.unbosque.edu.co/bitstreams/55f7ff0e-a4dc-4a63-bcab-caf8e8d81db2/download
https://repositorio.unbosque.edu.co/bitstreams/2bec0643-65fe-4d47-85ef-0f6e9b1f85f5/download
bitstream.checksum.fl_str_mv bb43559c3f08829ddc7d5103adb7efc5
3b6ce8e9e36c89875e8cf39962fe8920
17cc15b951e7cc6b3728a574117320f9
243a9f93d053c82fcfed062b4cb7269f
0a95aed31363b71e85245b878555d56f
68d0ff1adc3649750beb4f7cc67c61a7
2ac03edc529cfd915fdcb9ddcf762c35
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
MD5
MD5
MD5
MD5
repository.name.fl_str_mv Repositorio Institucional Universidad El Bosque
repository.mail.fl_str_mv bibliotecas@biteca.com
_version_ 1814100754527420416
spelling Guillermo , MadridMendoza O´Byrne, MarioMontoya Ruiz, María Camila2024-07-30T13:55:26Z2024-07-30T13:55:26Z2024-07https://hdl.handle.net/20.500.12495/12763instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coLos pacientes pediátricos sometidos a anestesia general corren el riesgo de desarrollar complicaciones pulmonares postoperatorias y, una proporción significativa adquirirá algún grado de lesión pulmonar aguda. El reclutamiento pulmonar es una estrategia que permite contrarrestar el desreclutamiento alveolar crónico que ocurre como resultado a los bajos volúmenes corriente. Por lo tanto, el objetivo principal de las maniobras de reclutamiento pulmonar es reducir la aparición de atelectasias, minimizando el área pulmonar no disponible. Evaluar la eficacia y seguridad de las maniobras de reclutamiento pulmonar sobre las atelectasias en pacientes pediátricos bajo anestesia general. Metodología: Se realizó una revisión sistemática y metaanálisis. Métodos de búsqueda: se identificaron ensayos clínicos con asignación aleatoria en el PubMed, Web of Science, Scopus, Cochrane Library y LILACS, hasta diciembre de 2021 sin restricciones en el idioma de publicación. Criterios de selección: ensayos clínicos controlados aleatorios que compararon las maniobras de reclutamiento pulmonar versus placebo en niños pulmonarmente sanos llevados a cirugía bajo anestesia general. El desenlace primario fue la incidencia de atelectasias postoperatorias. Los desenlaces secundarios fueron desaturación, distensibilidad pulmonar y eventos adversos. Recopilación y análisis de datos: dos autores evaluaron de forma independiente la calidad de los ensayos y extrajeron los datos. Análisis de los datos: se utilizó la metodología GRADE para analizar la calidad de la evidencia. Las variables continuas y dicotómicas fueron extraídas con medias ± desviación estándar y frecuencias respectivamente. Para las variables dicotómicas se calcularon riesgos relativos (RR) con intervalos de confianza del 95% y se metaanalizaron los datos según fuera apropiado.Hospital Universitario Fundación Santa Fe de BogotaEspecialista en AnestesiologíaEspecializaciónPediatric patients undergoing general anesthesia are at risk of developing postoperative pulmonary complications, with a significant proportion experiencing some degree of acute lung injury. Lung recruitment is a strategy aimed at counteracting chronic alveolar derecruitment that occurs due to low tidal volumes. Therefore, the primary objective of lung recruitment maneuvers is to reduce the occurrence of atelectasis, thereby minimizing unavailable lung area. To assess the efficacy and safety of lung recruitment maneuvers on atelectasis in pediatric patients under general anesthesia. A systematic review and meta-analysis were conducted. Search methods involved identifying randomized controlled trials in PubMed, Web of Science, Scopus, Cochrane Library, and LILACS up to December 2021, with no language restrictions. Selection criteria included randomized controlled trials comparing lung recruitment maneuvers versus placebo in pediatric patients without pulmonary comorbidities undergoing surgery under general anesthesia. The primary outcome was the incidence of postoperative atelectasis. Secondary outcomes included desaturation, pulmonary compliance, and adverse events. Data collection and analysis involved independent quality assessment and data extraction by two authors. GRADE methodology was utilized to assess the quality of evidence. Continuous variables were extracted as means ± standard deviation, and dichotomous variables as frequencies. Relative risks (RR) with 95% confidence intervals were calculated for dichotomous outcomes, and data were meta-analyzed as appropriate.application/pdfAtribución-NoComercial-CompartirIgual 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-sa/4.0/Acceso abiertoinfo:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Reclutamiento pulmonarAtelectasiasDistensibilidad pulmonarDesaturaciónAnestesia generalVentilación mecánicaLung recruitmentAtelectasisPulmonary complianceDesaturationGeneral anesthesiaMechanical ventilationWO 200Eficacia y seguridad de las maniobras de reclutamiento pulmonar en población pediátrica sin patología pulmonar: una revisión sistemática y metaanálisisEfficacy and safety of lung recruitment maneuvers in pediatric population without pulmonary pathology: a systematic review and meta-analysisEspecialización en AnestesiologíaUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aaKneyber MCJ. Intraoperative mechanical ventilation for the pediatric patient. Vol. 29, Best Practice and Research: Clinical Anaesthesiology. 2015.Feldman JM. Optimal ventilation of the anesthetized pediatric patient. Vol. 120, Anesthesia and Analgesia. 2015.Zanza C, Longhitano Y, Leo M, Romenskaya T, Franceschi F, Piccioni A, et al. Practical Review of Mechanical Ventilation in Adults and Children in the Operating Room and Emergency Department. Rev Recent Clin Trials. 2021;17(1).Kneyber MCJ, Jouvet PA, Rimensberger PC. How to manage ventilation in pediatric acute respiratory distress syndrome? Intensive Care Med [Internet]. 2014 Nov 21 [cited 2024 Jul 1];40(12):1924–6Dahlem P, van Aalderen WMC, Bos AP. Pediatric acute lung injury. Vol. 8, Paediatric Respiratory Reviews. 2007. p. 348–62.Tusman G, Böhm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Vol. 25, Current Opinion in Anaesthesiology. 2012.Martínez G, Cruz P. Atelectasias en anestesia general y estrategias de reclutamiento alveolar. Rev Esp Anestesiol Reanim [Internet]. 2008 Oct 1 [cited 2024 Jul 2];55(8):493–503Jauncey-Cooke J, East CE, Bogossian F. Paediatric lung recruitment: A review of the clinical evidence. Vol. 16, Paediatric Respiratory Reviews. 2015.Neto AS, Nagtzaam L, Schultz MJ. Ventilation with lower tidal volumes for critically ill patients without the acute respiratory distress syndrome: A systematic translational review and meta-Analysis. Curr Opin Crit Care. 2014 Feb;20(1):25–32.Plötz FB, Slutsky AS, Van Vught AJ, Heijnen CJ. Ventilator-induced lung injury and multiple system organ failure: A critical review of facts and hypotheses. Vol. 30, Intensive Care Medicine. 2004.Halbertsma FJJ, Vaneker M, Scheffer GJ, van der Hoeven JG. Cytokines and biotrauma in ventilator-induced lung injury: A critical review of the literature. Vol. 63, Netherlands Journal of Medicine. 2005.Boriosi JP, Sapru A, Hanson JH, Asselin J, Gildengorin G, Newman V, et al. Efficacy and safety of lung recruitment in pediatric patients with acute lung injury. Pediatric Critical Care Medicine. 2011;12(4).Wolthuis EK, Choi G, Dessing MC, Bresser P, Lutter R, Dzoljic M, et al. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology. 2008;108(1).Cui Y, Cao R, Li G, Gong T, Ou Y, Huang J. The effect of lung recruitment maneuvers on post-operative pulmonary complications for patients undergoing general anesthesia: A meta-analysis. PLoS One. 2019;14(5).Goligher EC, Hodgson CL, Adhikari NKJ, Meade MO, Wunsch H, Uleryk E, et al. Lung recruitment maneuvers for adult patients with acute respiratory distress syndrome: A systematic review and meta-analysis. Vol. 14, Annals of the American Thoracic Society. 2017.Kheir JN, Walsh BK, Smallwood CD, Rettig JS, Thompson JE, Gómez-Laberge C, et al. Comparison of 2 lung recruitment strategies in children with acute lung injury. Respir Care. 2013;58(8).Song IK, Kim EH, Lee JH, Ro S, Kim HS, Kim JT. Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial. Anaesthesia. 2017;72(2).Acosta CM, Sara T, Carpinella M, Volpicelli G, Ricci L, Poliotto S, et al. Lung recruitment prevents collapse during laparoscopy in children. Eur J Anaesthesiol. 2018;35(8).Duff JP, Rosychuk RJ, Joffe AR. The safety and efficacy of sustained inflations as a lung recruitment maneuver in pediatric intensive care unit patients. Intensive Care Med. 2007;33(10).Bruins S, Sommerfield D, Powers N, von Ungern-Sternberg BS. Atelectasis and lung recruitment in pediatric anesthesia: An educational review. Vol. 32, Paediatric Anaesthesia. 2022.He P, Wu C, Yang Y, Zheng J, Dong W, Wu J, et al. Effectiveness of postural lung recruitment on postoperative atelectasis assessed by lung ultrasound in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass. Pediatr Pulmonol. 2021;56(6).Gordo Vidal F, Delgado Arnaiz C, Calvo Herranz E. Lesión pulmonar inducida por la ventilación mecánica*. Med Intensiva [Internet]. 2007 Jan 1 [cited 2024 Jul 1];31(1):18–26.Parker JC, Hernandez LA, Peevy KJ. Mechanisms of ventilator-induced lung injury. Crit Care Med. 1993;21(1).Slutsky AS, Ranieri VM. Ventilator-Induced Lung Injury. New England Journal of Medicine [Internet]. 2013 Nov 28 [cited 2024 Jul 1];369(22):2126–36.Bendixen HH, Whyte H, Laver MB. Impaired Oxygenation in Surgical Patients during General Anesthesia with Controlled Ventilation. New England Journal of Medicine. 1963;269(19).Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Ruiz RM, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surg. 2017;152(2).Neto AS, Hemmes SNT, Barbas CSV, Beiderlinden M, Fernandez-Bustamante A, Futier E, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: A systematic review and meta-analysis. Lancet Respir Med. 2014;2(12).Mietto C, Pinciroli R, Patel N, Berra L. Ventilator associated pneumonia: Evolving definitions and preventive strategies. Respir Care. 2013;58(6).Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: Review and meta-analysis. Vol. 18, Critical Care. 2014.De Prost N, Dreyfuss D. How to prevent ventilator-induced lung injury? Vol. 78, Minerva Anestesiologica. 2012.Pelosi P, Negrini D. Extracellular matrix and mechanical ventilation in healthy lungs: Back to baro/volotrauma? Vol. 14, Current Opinion in Critical Care. 2008.Leme Silva P, Scharffenberg M, Rieken Macedo Rocco P. Understanding the mechanisms of ventilator-induced lung injury using animal models. Intensive Care Med Exp [Internet]. 2023 [cited 2024 Jul 1];11:82.Wilson MR, Choudhury S, Goddard ME, O’Dea KP, Nicholson AG, Takata M. High tidal volume upregulates intrapulmonary cytokines in an in vivo mouse model of ventilator-induced lung injury. J Appl Physiol. 2003;95(4).Lionetti V, Recchia FA, Ranieri VM. Overview of ventilator-induced lung injury mechanisms. Vol. 11, Current Opinion in Critical Care. 2005.Webb HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end expiratory pressure. AMERREVRESPDIS. 1974;110(5).Kolobow T, Moretti MP, Fumagalli R, Mascheroni D, Prato P, Chen V, et al. Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study. American Review of Respiratory Disease. 1987;135(2John E, Ermocilla R, Golden J, McDevitt M, Cassady G. Effects of intermittent positive-pressure ventilation of lungs of normal rabbits. Br J Exp Pathol. 1980;61(3).Goodman RB, Strieter RM, Martin DP, Steinberg KP, Milberg JA, Maunder RJ, et al. Inflammatory cytokines in patients with persistence of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1996;154(3 I).Chollet-Martin S, Jourdain B, Gibert C, Elbim C, Chastre J, Cougerot-Pocidalo MA. Interactions between neutrophils and cytokines in blood and alveolar spaces during ARDS. Am J Respir Crit Care Med. 1996;154(3 I).Colmenero-Ruiz M, Fernández-Mondéjar E, Fernández-Sacristán MA, Rivera-Fernández R, Vazquez-Mata G. PEEP and low tidal volume ventilation reduce lung water in porcine pulmonary edema. Am J Respir Crit Care Med. 1997;155(3).Duggan M, Kavanagh BP. Pulmonary AtelectasisA Pathogenic Perioperative Entity. Anesthesiology [Internet]. 2005 Apr 1 [cited 2024 Jul 3];102(4):838–54.Gajic O, Dara SI, Mendez JL, Adesanya AO, Festic E, Caples SM, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Vol. 32, Critical Care Medicine. 2004.Pinhu L, Whitehead T, Evans T, Griffiths M. Ventilator-associated lung injury. Lancet [Internet]. 2003 Jan 25 [cited 2024 Jul 7];361(9354):332–40.Coppola S, Froio S, Chiumello D. Protective lung ventilation during general anesthesia: Is there any evidence? Crit Care [Internet]. 2014 Mar 18 [cited 2024 Jul 2];18(2):1–7.Cai H, Gong H, Zhang L, Wang Y, Tian Y. Effect of low tidal volume ventilation on atelectasis in patients during general anesthesia: a computed tomographic scan. J Clin Anesth. 2007;19(2).Duggan M, Kavanagh BP. Pulmonary atelectasis: A pathogenic perioperative entity. Vol. 102, Anesthesiology. 2005.Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L. Pulmonary densities during anesthesia with muscular relaxation - A proposal of atelectasis. Anesthesiology. 1985;62(4).Hedenstierna G, Rothen HU. Atelectasis formation during anesthesia: Causes and measures to prevent it. Vol. 16, Journal of Clinical Monitoring and Computing. 2000.Woo SW, Berlin D, Hedley-Whyte J. Surfactant function and anesthetic agents. J Appl Physiol. 1969;26(5).Tobin WR, Kaiser HE, Groeger AM, Lema MJ. The effects of volatile anesthetic agents on pulmonary surfactant function. Vol. 14, In Vivo. 2000.Otis DR, Johnson M, Pedley TJ, Kamm RD. Role of pulmonary surfactant in airway closure: A computational study. J Appl Physiol. 1993;75(3).Nguyen T kien, Mai DH, Le AN, Nguyen QH, Nguyen CT, Vu TA. A review of intraoperative lung-protective mechanical ventilation strategy. Vol. 37, Trends in Anaesthesia and Critical Care. 2021.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. New England Journal of Medicine. 2013;369(5).Wrigge H, Zinserling J, Stuber F, Von Spiegel T, Hering R, Wetegrove S, et al. Effects of mechanical ventilation on release of cytokines into systemic circulation in patients with normal pulmonary function. Anesthesiology. 2000;93(6).Wrigge H, Uhlig U, Zinserling J, Behrends-Callsen E, Ottersbach G, Fischer M, et al. The Effects of Different Ventilatory Settings on Pulmonary and Systemic Inflammatory Responses during Major Surgery. Anesth Analg. 2004;98(3).Severgnini P, Selmo G, Lanza C, Chiesa A, Frigerio A, Bacuzzi A, et al. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology. 2013;118(6).Hemmes SNT, Severgnini P, Jaber S, Canet J, Wrigge H, Hiesmayr M, et al. Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery. Trials. 2011;12.Jaber S, Coisel Y, Chanques G, Futier E, Constantin JM, Michelet P, et al. A multicentre observational study of intra-operative ventilatory management during general anaesthesia: Tidal volumes and relation to body weight. Anaesthesia. 2012;67(9).Hess DR, Kondili D, Burns E, Bittner EA, Schmidt UH. A 5-year observational study of lung-protective ventilation in the operating room: A single-center experience. J Crit Care. 2013 Aug 1;28(4):533.e9-533.e15.Moriondo A, Marcozzi C, Bianchin F, Reguzzoni M, Severgnini P, Protasoni M, et al. Impact of mechanical ventilation and fluid load on pulmonary glycosaminoglycans. Respir Physiol Neurobiol [Internet]. 2012 May 31 [cited 2024 Jul 7];181(3):308–20.Wolthuis EK, Vlaar APJ, Choi G, Roelofs JJTH, Juffermans NP, Schultz MJ. Mechanical ventilation using non-injurious ventilation settings causes lung injury in the absence of pre-existing lung injury in healthy mice. Crit Care [Internet]. 2009 [cited 2024 Jul 7];13(1).Zupancich E, Paparella D, Turani F, Munch C, Rossi A, Massaccesi S, et al. Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery: A randomized clinical trial. Journal of Thoracic and Cardiovascular Surgery [Internet]. 2005 Aug [cited 2024 Jul 7];130(2):378–83.Schilling T, Kozian A, Huth C, Bühling F, Kretzschmar M, Welte T, et al. The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery. Anesth Analg [Internet]. 2005 [cited 2024 Jul 7];101(4):957–65.Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6).Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: Patient safety summit on definition, risk-reducing interventions, and preventive strategies. Vol. 39, Critical Care Medicine. 2011.Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997;111(3).Brooks-Brunn JA. Postoperative atelectasis and pneumonia: risk factors. Vol. 4, American journal of critical care : an official publication, American Association of Critical-Care Nurses. 1995.Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg. 2000;232(2).Ferreyra GP, Baussano I, Squadrone V, Richiardi L, Marchiaro G, Del Sorbo L, et al. Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: A systematic review and meta-analysis. Ann Surg. 2008;247(4).Lusquinhos J, Tavares M, Abelha F. Postoperative Pulmonary Complications and Perioperative Strategies: A Systematic Review. 2023;Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation in postoperative patients: a systematic review. Intensive Care Med [Internet]. 2011 Jun [cited 2024 Jul 7];37(6):918–29.Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6).Sigona A, Richman DC. Identifying and reducing risks of postoperative pulmonary complications. Journal of Oral and Maxillofacial Anesthesia [Internet]. 2023 Dec 30 [cited 2024 Jul 7];2(0):30–30.Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: A 7 day cohort study. The Lancet. 2012;380(9847).Tsumura H, Harris E, Brandon D, Pan W, Vacchiano C. Review of the Mechanisms of Ventilator Induced Lung Injury and the Principles of Intraoperative Lung Protective Ventilation. AANA J. 2021;89(3).Park SJ, Kim BG, Oh AH, Han SH, Han HS, Ryu JH. Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial. Surg Endosc [Internet]. 2016 Oct 1 [cited 2024 Jul 7];30(10):4598–606.Lagier D, Zeng C, Fernandez-Bustamante A, Vidal Melo MF. Perioperative Pulmonary Atelectasis: Part II. Clinical Implications. Vol. 136, Anesthesiology. 2022.Kelkar KV. Post-operative pulmonary complications after non-cardiothoracic surgery. Indian J Anaesth [Internet]. 2015 Sep 1 [cited 2024 Jul 8];59(9):599.Poelaert J, Szegedi L, Blot S. Prevention of Postoperative Pulmonary Problems Starts Intraoperatively. Annual Update in Intensive Care and Emergency Medicine 2013 [Internet]. 2013 [cited 2024 Jul 8];539–52.Tokics L, Hedenstierna G, Strandberg A, Brismar B, Lundquist H. Lung collapse and gas exchange during general anesthesia: Effects of spontaneous breathing, muscle paralysis, and positive end-expiratory pressure. Anesthesiology. 1987;66(2).Magnusson L. New concepts of atelectasis during general anaesthesia. Br J Anaesth. 2003;91(1).Ty C, Eva C, Chan YF. Postoperative pulmonary complications and their prevention.Ko E, Yoo KY, Lim CH, Jun S, Lee K, Kim YH. Is atelectasis related to the development of postoperative pneumonia? a retrospective single center study. BMC Anesthesiol. 2023;23(1).Saikia D, Mahanta B. Cardiovascular and respiratory physiology in children. Indian J Anaesth [Internet]. 2019 Sep 1 [cited 2024 Jul 8];63(9):690.Gonzalez LP, Pignaton W, Kusano PS, Módolo NSP, Braz JRC, Braz LG. Anesthesia-related mortality in pediatric patients: A systematic review. Vol. 67, Clinics. 2012.Tay CLM, Tan GM, Ng SBA. Critical incidents in paediatric anaesthesia: An audit of 10 000 anaesthetics in Singapore. Paediatr Anaesth. 2001;11(6).Gerhardt T, Hehre D, Feller R, Reifenberg L, Bancalari E. Pulmonary mechanics in normal infants and young children during first 5 years of life. Pediatr Pulmonol. 1987;3(5).Lanteri CJ, Sly PD. Changes in respiratory mechanics with age. J Appl Physiol. 1993;74(1).Narayanan M, Owers-Bradley J, Beardsmore CS, Mada M, Ball I, Garipov R, et al. Alveolarization continues during childhood and adolescence: New evidence from helium-3 magnetic resonance. Am J Respir Crit Care Med. 2012;185(2).Tepper RS, Williams T, Kisling J, Castile R. Static compliance of the respiratory system in healthy infants. Am J Respir Crit Care Med. 2001;163(1).Dunnill MS. The problem of lung growth. Vol. 37, Thorax. 1982.Papastamelos C, Panitch HB, England SE, Allen JL. Developmental changes in chest wall compliance in infancy and early childhood. J Appl Physiol. 1995;78(1).Santschi M, Randolph AG, Rimensberger PC, Jouvet P. Mechanical ventilation strategies in children with acute lung injury: A survey on stated practice pattern. Pediatric Critical Care Medicine. 2013;14(7).Randolph AG. Management of acute lung injury and acute respiratory distress syndrome in children. Crit Care Med [Internet]. 2009 [cited 2024 Jul 9];37(8):2448–54.Plötz FB, Vreugdenhil HA, Slutsky AS, Zijlstra J, Heijnen CJ, Van Vught H. Mechanical ventilation alters the immune response in children without lung pathology. Intensive Care Med. 2002;28(4).Kneyber MCJ, Zhang H, Slutsky AS. Ventilator-induced lung injury: Similarity and differences between children and adults. Vol. 190, American Journal of Respiratory and Critical Care Medicine. 2014.Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, et al. Acute lung injury in pediatric intensive care in Australia and New Zealand - A prospective, multicenter, observational study. Pediatric Critical Care Medicine. 2007;8(4).Khemani RG, Conti D, Alonzo TA, Bart RD, Newth CJL. Effect of tidal volume in children with acute hypoxemic respiratory failure. Intensive Care Med. 2009;35(8).Kneyber MCJ, Rimensberger PC. The need for and feasibility of a pediatric ventilation trial: Reflections on a survey among pediatric intensivists. Vol. 13, Pediatric Critical Care Medicine. 2012.Bachiller PR, McDonough JM, Feldman JM. Do new anesthesia ventilators deliver small tidal volumes accurately during volume-controlled ventilation? Anesth Analg. 2008;106(5).Ingaramo OA, Ngo T, Khemani RG, Newth CJL. Impact of positive end-expiratory pressure on cardiac index measured by ultrasound cardiac output monitor. Pediatric Critical Care Medicine. 2014;15(1).Güldner A, Kiss T, Serpa Neto A, Hemmes SNT, Canet J, Spieth PM, et al. Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications. Anesthesiology. 2015;123(3).Tao T, Bo L, Chen F, Xie Q, Zou Y, Hu B, et al. Effect of protective ventilation on postoperative pulmonary complications in patients undergoing general anaesthesia: A meta-analysis of randomised controlled trials. BMJ Open. 2014;4(6).O’Gara B, Talmor D. Perioperative lung protective ventilation. Vol. 362, BMJ (Clinical research ed.). 2018.Arango-Granados MC, Ariza F. Ventilación protectora y maniobras de reclutamiento pulmonar en cirugía mayor. Revista Argentina de Anestesiología. 2016;74(1).Hedenstierna G, Tenling A. The lung during and after thoracic anaesthesia. Vol. 18, Current Opinion in Anaesthesiology. 2005.Serpa Neto A, Hemmes SNT, Barbas CS V, Beiderlinden M, Biehl M, Binnekade JM, et al. Protective versus Conventional Ventilation for Surgery. Anesthesiology. 2015;123(1).Lovas A, Szakmány T. Haemodynamic Effects of Lung Recruitment Manoeuvres. Vol. 2015, BioMed Research International. 2015.Garnero A, Tuxen D, Corno G, Durand-Gasselin J, Hodgson C, Arnal JM. Dynamics of end expiratory lung volume after changing positive end-expiratory pressure in acute respiratory distress syndrome patients. Crit Care. 2015;19(1).Xia F, Pan C, Wang L, Liu L, Liu S, Guo F, et al. Physiological effects of different recruitment maneuvers in a pig model of ARDS. BMC Anesthesiol. 2020;20(1).Devor R, Bassi H, Kang P, Morandi T, Richardson K, Nigro J, et al. Safety and efficacy of lung recruitment maneuvers in pediatric post-operative cardiac patients. Southwest J Pulm Crit Care. 2020 Jan 10;20(1):16–28.Bhalla AK, Khemani R. Recruitment maneuvers to the extreme. Vol. 61, Respiratory Care. 2016.Pelosi P, de Abreu MG, Rocco PRM. New and conventional strategies for lung recruitment in acute respiratory distress syndrome. Vol. 14, Critical Care. 2010.Rabbitts JA, Groenewald CB. Epidemiology of Pediatric Surgery in the United States.Jang YE, Ji SH, Kim EH, Lee JH, Kim JT, Kim HS. Effect of regular alveolar recruitment on intraoperative atelectasis in paediatric patients ventilated in the prone position: a randomised controlled trial. Br J Anaesth. 2020;124(5).Amato MBP, Valente Barbas CS, Medeiros DM, Magaldi RB, De Pinto Schettino G, Lorenzi-Filho G, et al. Effect of a protective ventilation strategy on mortality in the acute respiratory distress syndrome. Pneumologie. 1998;52(5).O’Gara B, Talmor D. Lung protective properties of the volatile anesthetics. Intensive Care Med. 2016;42(9).Jabaudon M, Futier E, Roszyk L, Sapin V, Pereira B, Constantin JM. Association between intraoperative ventilator settings and plasma levels of soluble receptor for advanced glycation end-products in patients without pre-existing lung injury. Respirology. 2015;20(7).Lundquist H, Hedenstierna G, Strandberg, Tokics L, Brismar B. CT-assessment of dependent lung densities in man during general anaesthesia. Acta radiol. 1995;36(4–6).Hess DR. Recruitment Maneuvers and PEEP Titration. Respir Care [Internet]. 2015 Nov 1 [cited 2024 Jul 10];60(11):1688–704.Egbert LD, Laver MB, Bendixen HH. Intermittent Deep Breaths and Compliance During Anesthesia in Man. Anesthesiology. 1963;24(1).Reinius H, Jonsson L, Gustafsson S, Sundbom M, Duvernoy O, Pelosi P, et al. Prevention of Atelectasis in Morbidly Obese Patients during General Anesthesia and ParalysisA Computerized Tomography Study. Anesthesiology [Internet]. 2009 Nov 1 [cited 2024 Jul 10];111(5):979–87.Futier E, Constantin JM, Pelosi P, Chanques G, Kwiatkoskwi F, Jaber S, et al. Intraoperative Recruitment Maneuver Reverses Detrimental Pneumoperitoneum-induced Respiratory Effects in Healthy Weight and Obese Patients Undergoing Laparoscopy. Anesthesiology [Internet]. 2010 Dec 1 [cited 2024 Jul 10];113(6):1310–9.Whalen FX, Gajic O, Thompson GB, Kendrick ML, Que FL, Williams BA, et al. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg. 2006;102(1):298–305.Choi ES, Oh AY, In CB, Ryu JH, Jeon YT, Kim HG. Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy: A randomised single-blinded trial. PLoS One [Internet]. 2017 Sep 1 [cited 2024 Jul 10];12(9).spaORIGINALTrabajo final.pdfTrabajo final.pdfapplication/pdf1832619https://repositorio.unbosque.edu.co/bitstreams/5aae367a-a9c5-4834-96ca-b684beb40b0e/downloadbb43559c3f08829ddc7d5103adb7efc5MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8899https://repositorio.unbosque.edu.co/bitstreams/577593f9-1795-4a30-8361-c5d73ad3f3ab/download3b6ce8e9e36c89875e8cf39962fe8920MD53LICENSElicense.txtlicense.txttext/plain; charset=utf-82000https://repositorio.unbosque.edu.co/bitstreams/9198b456-1849-4e05-8012-a7756c70ff8d/download17cc15b951e7cc6b3728a574117320f9MD54Carta de autorización.pdfapplication/pdf170246https://repositorio.unbosque.edu.co/bitstreams/f761f3c7-9e64-4260-ac51-a8a0c9c44ef1/download243a9f93d053c82fcfed062b4cb7269fMD55Acta de grado.pdfapplication/pdf172782https://repositorio.unbosque.edu.co/bitstreams/e7c92bb5-c563-4ea5-8e04-2bc0a610b838/download0a95aed31363b71e85245b878555d56fMD56TEXTTrabajo final.pdf.txtTrabajo final.pdf.txtExtracted texttext/plain101539https://repositorio.unbosque.edu.co/bitstreams/55f7ff0e-a4dc-4a63-bcab-caf8e8d81db2/download68d0ff1adc3649750beb4f7cc67c61a7MD57THUMBNAILTrabajo final.pdf.jpgTrabajo final.pdf.jpgGenerated Thumbnailimage/jpeg3112https://repositorio.unbosque.edu.co/bitstreams/2bec0643-65fe-4d47-85ef-0f6e9b1f85f5/download2ac03edc529cfd915fdcb9ddcf762c35MD5820.500.12495/12763oai:repositorio.unbosque.edu.co:20.500.12495/127632024-08-01 03:04:37.271http://creativecommons.org/licenses/by-nc-sa/4.0/Atribución-NoComercial-CompartirIgual 4.0 Internacionalembargo2024-12-29https://repositorio.unbosque.edu.coRepositorio Institucional Universidad El Bosquebibliotecas@biteca.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

Publicaciones similares