Resumen

PERIS-MONTALT, Raquel; GARCIA-DIHINX, Itziar de la Cruz; ERRANDO, Carlos L  y  GRANELL, Manuel. Effects of intraoperative mechanical ventilation and of pulmonary protective ventilation in the adult surgical patient. Medicas UIS [online]. 2015, vol.28, n.1, pp.65-78. ISSN 0121-0319.

Introduction: artificial ventilation is essential for an adequate gas interchange during general anesthesia, it has been used with high tidal volume to prevent hypoxemia and atelectasis, but high tidal volumes and high plateau pressures might aggravate or start a lung injury. Pulmonary protective ventilation consists of use of low tidal volumes, limit plateau pressure to minimize overdistension and use positive pressure at the end of expiration and controlled ventilation. Objective: to analize the evidence on the possible benefit of protective pulmonary ventilation during surgery with bipulmonar or unipulmonar controlled ventilation. Materials and Methods: the Pubmed-Medline database was searched for years 2010-2014 for articles on clinical and pathophysiological reviews, systematic reviews, metaanalysis, observational studies, and randomized controlled trials. A total of 2031 articles were included. Results: most studies using pulmonary protective ventilation: tidal volume 6-8 ml/kg, positive end expiratory pressure 4-8 cmH2O and recruitment maneuvers, showed improved physiologic and ventilatory parameters. Some investigations offered not homogeneous results; however, the clinical evidence of improvement is not as clear. Studies with wide sample sizes showed increased respiratory morbimortality in patients in whom this strategy was not applied. Conclusions: application of protective pulmonary ventilation strategies might improve the immediate and delayed prognostic and outcomes, specially respiratory of normal sugical patients. Special populations could benefit of these stratiegies. MÉD.UIS. 2015;28(1):65-78

Palabras clave : Anesthesia; Respiration; artificial; One-Lung Ventilation; Surgery; Thoracic Surgery.

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