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Fecha Publicación: 2014-06-20
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Ospina Argüelles, D. A. ., Buriticá Gaviria, E. . F. ., Echeverry Bonilla, D. F. ., Villanueva Rodríguez, . C. L. ., & Rondón Barragán, I. S. . (2014). Maniobras de reclutamiento alveolar en el control de la atelectasia pulmonar. Revista Veterinaria Y Zootecnia (On Line), 8(1), 17–34. Recuperado a partir de https://revistasojs.ucaldas.edu.co/index.php/vetzootec/article/view/4370
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Resumen: El colapso parcial o total del pulmón o un lóbulo pulmonar denominado atelectasia es una de las principales complicaciones en los pacientes asistidos con ventilación mecánica en la unidad de cuidados intensivos y en el periodo perioperatorio. Los principales factores por los cuales los alvéolos entran en atelectasia son: la compresión del tejido pulmonar, la absorción del gas alveolar, y la pérdida de función del surfactante alveolar. Para contrarrestar la atelectasia se emplean diversas maniobras de reclutamiento alveolar, las cuales buscan reabrir los alvéolos colapsados durante el mayor tiempo posible. Se debe tener especial precaución en los pacientes con compromiso cardiovascular puesto que estas maniobras pueden generar alteraciones en este sistema. Dentro de las maniobras más utilizadas se encuentran la presión positiva continua en la vía aérea, presión positiva al final de la espiración, maniobra de capacidad vital, posición prona y suspiros intermitentes. El presente trabajo tiene como objetivo describir los principales mecanismos de formación de atelectasias así como las más importantes maniobras de reclutamiento alveolar potencialmente aplicables en medicina veterinaria.
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Brismar, B.; Hedenstierna, G.; Lundquist, H. et al. Pulmonary densities during anesthesia with muscular relaxation – a proposal of atelectasis. Anesthesiology, v.62, n.4, p.422-428, 1985.
Canfrán, S. Efectos pulmonares y hemodinámicos del reclutamiento alveolar progresivo durante la anestesia en el perro. Madrid, España: Universidad Complutense de Madrid, 2013. 202 p. Tesis Doctoral.
Carney, D.; Bredenberg, C.; Schiller, H. et al. The mechanism of lung volume change during mechanical ventilation. American Journal of Respiratory and Critical Care Medicine, v.160, n.1, p.1697-1702, 1999.
Celebi, S.; Koner, O.; Menda, F. et al. The pulmonary and hemodynamic effects of two different recruitment maneuvers after cardiac surgery. Anesthesia & Analgesia, v.104, n.2, p.384-390, 2007.
Derek, F. Anaesthetic Drugs. In: Welsh, L. (Ed). Anaesthesia for veterinary nurses. Iowa: WileyBlackwell, 2009. p.121-161.
Duggan, M.; Kavanagh, B.P. Pulmonary atelectasis: A pathogenic perioperative entity. Anesthesiology, v.102, n.4, p.838-854, 2005.
Eichenberger, A.; Proietti, S.; Wicky, S. et al. Morbid obesity and postoperative pulmonary atelectasis: An underestimated problem. Anesthesia & Analgesia, v.95, n.6, p.1788-1792, 2002.
Fuhrman, B. Avoidance of ventilator induced lung injury. Acta Pharmacologica Sinica, v.23, p.44-47 2002 (suppl.1).
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Kavanagh, B.P. Perioperative atelectasis. Minerva Anestesiologica, v.74, n.6, p.285-287, 2008.
Klemm, M.; Alvarenga, J.; Fantoni, D. et al. Estudo comparativo dos efeitos da ventilação mecânica controlada (VMC) com ou sem o emprego da pressão positiva no final da expiração (PEEP) sobre a variação da pressão interpleural em anestesia eqüina. Brazilian Journal of Veterinary Research and Animal Science, v.35, n.6, p.260-265, 1998.
Lachmann, B. Open up the lung and keep the lungs open. Intensive Care Medicine, v.18, n.6, p.319-321, 1992.
Lam, W.W.; Chen, P.P.; So, N.M. et al. Sedation versus general anaesthesia in paediatric patients undergoing chest CT. Acta Radiológica, v.39, n.3, p.298-300, 1998.
Lindberg, P.; Gunnarsson, L.; Tokics, L. et al. Atelectasis and lung function in the postoperative period. Acta Anaesthesiologica Scandinavica, v.36, n.6, p.546- 553, 1992.
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Magnusson, L.; Spahn, D.R. New concepts of atelectasis during general anaesthesia. British Journal of Anaesthesia, v.91, n.1, p.61-72, 2003.
Malbouisson, L.M.; Humberto, F.; Rodrigues, R.R. et al. Atelectasis during anesthesia: Pathophysiology and treatment. Revista Brasileira de Anestesiologia, v.58, n.1, p.73-83, 2008.
Martínez, G.; Cruz, P. Atelectasias en anestesia general y estrategias de reclutamiento alveolar. Revista Española de Anestesiología y Reanimación, v.55, n.1, p.493-503, 2008.
Mosing, M.; German, A.J.; Holden, S.L. et al. Oxygenation and ventilation characteristics in obese sedated dogs before and after weight loss: A clinical trial. The Veterinary Journal, v.198, n.1, p.367-371, 2013.
Murphy, G.S.; Szokol, J.W.; Curran, R.D. et al. Influence of a vital capacity maneuver on pulmonary gas exchange after cardiopulmonary bypass. Journal of Cardiothoracic and Vascular Anesthesia, v.15, n.3, p.336-340, 2001.
Neumann, P.; Rothen, H.U.; Berglund, J.E. et al. Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiologica Scandinavica, v.43, n.3, p.295-301, 1999.
Nielsen, J.; Østergaard, M.; Kjaergaard, J. et al. Lung recruitment maneuver depresses central hemodynamics in patients following cardiac surgery. Intensive Care Medicine, v.31, n.9, p.1189-1194, 2005.
Nielsen, J.; Nilsson, M.; Fredén, F. et al. Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continous pulmonary artery flow measurements in lung-injured pigs. Intensive Care Medicine, v.32, n.4, p.585-594, 2006.
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Oczenski, W.; Schwarz, S.; Fitzgerald, R.D. Vital capacity manoeuvre in general anaesthesia: Useful or useless? European Journal of Anaesthesiology, v.21, n.4, p.253-259, 2004.
Odenstedt, H.; Lindgren, S.; Olegård, C. et al. Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: Evaluation of recruitment maneuvers using electric impedance tomography. Intensive Care Medicine, v.31, n.12, p.1706-1714, 2005.
Papadakos, P.J.; Lachmann, B. The open lung concept of mechanical ventilation: The role of recruitment and stabilization. Critical Care Clinics, v.23, n.2, p.241- 250, 2007.
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Pelosi, P.; D’Onofrio, D.; Chiumello, D. et al. Pulmonary and extrapulmonary acute respiratory distress syndrome are different. European Journal of Anaesthesiology, v.22, p.48s-56s, 2003 (suppl.42).
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Staffieri, F.; De Monte, V.; De Marzo, C. et al. Alveolar recruiting maneuver in dogs under general anesthesia: effects on alveolar ventilation, gas exchange, and respiratory mechanics. Veterinary Research Communications, v.34, p.S131-S134, 2010a (suppl.1).
Staffieri, F.; De Monte, V.; De Marzo, C. et al. Effects of two fractions of inspired oxygen on lung aeration and gas exchange in cats under inhalant anaesthesia. Veterinary Anesthesia & Analgesia, v.37, n.6, p.483- 490, 2010b.
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Amato, M.B.; Barbas, C.S; Medeiros, D.M. et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. The New England Journal of Medicine, v.338, n.6, p.347-354, 1998.
Bendixen, H.H.; Hedley-Whyte, J.; Chir, B. et al. Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation. The New England Journal of Medicine, v.269, n.7, p.991-996, 1963. Benoit, Z.; Wicky, S.; Fischer, J.F. et al. The effect of increased FIO2 before tracheal extubation on postoperative atelectasis. Anesthesia & Analgesia, v.95, n.6, p.1777-1781, 2002.
Brismar, B.; Hedenstierna, G.; Lundquist, H. et al. Pulmonary densities during anesthesia with muscular relaxation – a proposal of atelectasis. Anesthesiology, v.62, n.4, p.422-428, 1985.
Canfrán, S. Efectos pulmonares y hemodinámicos del reclutamiento alveolar progresivo durante la anestesia en el perro. Madrid, España: Universidad Complutense de Madrid, 2013. 202 p. Tesis Doctoral.
Carney, D.; Bredenberg, C.; Schiller, H. et al. The mechanism of lung volume change during mechanical ventilation. American Journal of Respiratory and Critical Care Medicine, v.160, n.1, p.1697-1702, 1999.
Celebi, S.; Koner, O.; Menda, F. et al. The pulmonary and hemodynamic effects of two different recruitment maneuvers after cardiac surgery. Anesthesia & Analgesia, v.104, n.2, p.384-390, 2007.
Derek, F. Anaesthetic Drugs. In: Welsh, L. (Ed). Anaesthesia for veterinary nurses. Iowa: WileyBlackwell, 2009. p.121-161.
Duggan, M.; Kavanagh, B.P. Pulmonary atelectasis: A pathogenic perioperative entity. Anesthesiology, v.102, n.4, p.838-854, 2005.
Eichenberger, A.; Proietti, S.; Wicky, S. et al. Morbid obesity and postoperative pulmonary atelectasis: An underestimated problem. Anesthesia & Analgesia, v.95, n.6, p.1788-1792, 2002.
Fuhrman, B. Avoidance of ventilator induced lung injury. Acta Pharmacologica Sinica, v.23, p.44-47 2002 (suppl.1).
Gattinoni, L.; D’Andrea, L.; Pelosi, P. et al. Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. The Journal of the American Medical Association, v.269, n.16, p.2122-2127, 1993.
Gerhardt, T.; Bancalari, E. Chestwall compliance in fullterm and premature infants. Acta Paediatrica Scandinavica, v.69, n.3, p.359-364, 1980.
Gil, A.; Monge, M.I.; Gracia, M. et al. Incidencia, características y evolución del barotrauma durante la ventilación mecánica con apertura pulmonar. Medicina intensiva, v.36, n.5, p.335-342, 2013.
Guyton, A.C.; Hall, J.E. Tratado de fisiología médica. 12 ed. Barcelona, España: Saunders Elsevier, 2011. p.1092.
Hedenstierna, G. Gas Exchange during anaesthesia. British Journal of Anaesthesia, v.34, n.1, p.27-31, 1990.
Hedenstierna, G.; Rothen, H.U. Atelectasis formation during anesthesia: Causes and measures to prevent it. Journal of Clinical Monitoring and Computing, v.16, n.1, p.329-335, 2000.
Hedenstierna, G.; Edmark, L. The effects of anesthesia and muscle paralysis on the respiratory system. Intensive Care Medicine, v.31, n.10, p.1327-1335, 2005.
Hedenstierna, G.; Edmark, L. Mechanisms of atelectasis in the operative period. Best Practice and the Research Clinical Anesthesiology, v.24, n.2, p.157-159, 2010.
Hedenstierna, G.; Larsson, A. Does PEEP matter in the OR? Trends in Anaesthesia and Critical Care, v.24, n.1, p.77-80, 2012.
Ibancovichi, J.; Moran, R.; Acevedo, M. et al. Introducción a la ventilación mecánica en la unidad de cuidados críticos. Revista de la Asociación Mexicana de Médicos Veterinarios Especialistas en Pequeñas Especies, v.20, n.5, p.128-132, 2009.
Kavanagh, B.P. Lung recruitment in real time: Learning was never so easy. American Journal of Respiratory and Critical Care Medicine, v.167, n.12, p.1585-1586, 2003.
Kavanagh, B.P. Perioperative atelectasis. Minerva Anestesiologica, v.74, n.6, p.285-287, 2008.
Klemm, M.; Alvarenga, J.; Fantoni, D. et al. Estudo comparativo dos efeitos da ventilação mecânica controlada (VMC) com ou sem o emprego da pressão positiva no final da expiração (PEEP) sobre a variação da pressão interpleural em anestesia eqüina. Brazilian Journal of Veterinary Research and Animal Science, v.35, n.6, p.260-265, 1998.
Lachmann, B. Open up the lung and keep the lungs open. Intensive Care Medicine, v.18, n.6, p.319-321, 1992.
Lam, W.W.; Chen, P.P.; So, N.M. et al. Sedation versus general anaesthesia in paediatric patients undergoing chest CT. Acta Radiológica, v.39, n.3, p.298-300, 1998.
Lindberg, P.; Gunnarsson, L.; Tokics, L. et al. Atelectasis and lung function in the postoperative period. Acta Anaesthesiologica Scandinavica, v.36, n.6, p.546- 553, 1992.
Luengo, A.; Carvajal, C. Atelectasias intraoperatorias, mecanismos de formación y estrategias de prevención. Revista Chilena de Anestesia, v.42, n.1, p.167-79, 2013.
Lumb, A.B. Just a little oxygen to breathe as you go off to sleepy is it always a good idea? British Journal of Anaesthesia, v.99, n.6, p.769-771, 2007. Magnusson, L.; Zemgulis, V.; Wicky, S. et al. Atelectasis is a major cause of hypoxemia and shunt after cardiopulmonary bypass: An experimental study. Anesthesiology, v.87, n.5, p.1153-1163, 1997.
Magnusson, L.; Spahn, D.R. New concepts of atelectasis during general anaesthesia. British Journal of Anaesthesia, v.91, n.1, p.61-72, 2003.
Malbouisson, L.M.; Humberto, F.; Rodrigues, R.R. et al. Atelectasis during anesthesia: Pathophysiology and treatment. Revista Brasileira de Anestesiologia, v.58, n.1, p.73-83, 2008.
Martínez, G.; Cruz, P. Atelectasias en anestesia general y estrategias de reclutamiento alveolar. Revista Española de Anestesiología y Reanimación, v.55, n.1, p.493-503, 2008.
Mosing, M.; German, A.J.; Holden, S.L. et al. Oxygenation and ventilation characteristics in obese sedated dogs before and after weight loss: A clinical trial. The Veterinary Journal, v.198, n.1, p.367-371, 2013.
Murphy, G.S.; Szokol, J.W.; Curran, R.D. et al. Influence of a vital capacity maneuver on pulmonary gas exchange after cardiopulmonary bypass. Journal of Cardiothoracic and Vascular Anesthesia, v.15, n.3, p.336-340, 2001.
Neumann, P.; Rothen, H.U.; Berglund, J.E. et al. Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiologica Scandinavica, v.43, n.3, p.295-301, 1999.
Nielsen, J.; Østergaard, M.; Kjaergaard, J. et al. Lung recruitment maneuver depresses central hemodynamics in patients following cardiac surgery. Intensive Care Medicine, v.31, n.9, p.1189-1194, 2005.
Nielsen, J.; Nilsson, M.; Fredén, F. et al. Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continous pulmonary artery flow measurements in lung-injured pigs. Intensive Care Medicine, v.32, n.4, p.585-594, 2006.
O’Brien, J. Absorption Atelectasis: Incidence and Clinical Implications. American Association of Nurse Anesthetists Journal, v.81, n.3, p.205-208, 2013.
Ochagavia, A.; Blanch, L.; López-Aguilar, J. Utilidad de las maniobras de reclutamiento (contra). Medicina Intensiva, v.33, n.3, p.139-143, 2009.
Oczenski, W.; Schwarz, S.; Fitzgerald, R.D. Vital capacity manoeuvre in general anaesthesia: Useful or useless? European Journal of Anaesthesiology, v.21, n.4, p.253-259, 2004.
Odenstedt, H.; Lindgren, S.; Olegård, C. et al. Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: Evaluation of recruitment maneuvers using electric impedance tomography. Intensive Care Medicine, v.31, n.12, p.1706-1714, 2005.
Papadakos, P.J.; Lachmann, B. The open lung concept of mechanical ventilation: The role of recruitment and stabilization. Critical Care Clinics, v.23, n.2, p.241- 250, 2007.
Pelosi, P.; Croci, M.; Ravagnan, I. et al. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. Journal of Applied Physiology, v.82, n.3, p.811-818, 1997.
Pelosi, P.; D’Onofrio, D.; Chiumello, D. et al. Pulmonary and extrapulmonary acute respiratory distress syndrome are different. European Journal of Anaesthesiology, v.22, p.48s-56s, 2003 (suppl.42).
Perasso, O.; Capurro, J.; Sanz, R. et al. Maniobras de reclutamiento alveolar. Revista argentina de anestesiología, v.64, n.5, p.201-215, 2006.
Rama-Maceiras, P. Atelectasias perioperatorias y maniobras de reclutamiento alveolar. Archivos de Bronconeumología, v.46, n.6, p.317-324, 2010.
Reber, A.; Nylund, U.; Hedenstierna, G. Position and shape of the diaphragm: implications for atelectasis formation. Anaesthesia, v. 53, n.11, p.1054-1061, 1998.
Rothen, H.U.; Sporre, B.; Engberg, G. et al. Reexpansion of atelectasis during general anaesthesia: a computed tomography study. British Journal of Anaesthesia, v.71, n.6, p.788-795, 1993.
Rusca, M.; Proietti, S.; Schnyder, P. et al. Prevention of atelectasis formation during induction of general anesthesia. Anesthesia & Analgesia, v.97, n.6, p.1835-9, 2003.
Schilling, T.; Kozian, A.; Huth, C. et al. The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery. Anesthesia and analgesia, v.101, n.4, p.957-965, 2005.
Spieth, P.M.; Carvalho, A.R.; Pelosi, P. et al. Variable tidal volumes improve lung protective ventilation estrategies in experimental lung injury. American Journal of Respiratory and Critical Care Medicine, v.179, n.8, p.684-693, 2009.
Sprung, J.; Whalley, D.G.; Falcone, T. et al. The impact of morbid obesity, pneumoperitoneum, and posture on respiratory system mechanics and oxygenation during laparoscopy. Anesthesia & Analgesia, v.94, n.5, p.1345-50, 2002.
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