Influence of intra-abdominal hypertension on the respiratory mechanics of critically ill adult patients with invasive mechanical ventilation

Objective: to describe the modifications in respiratory mechanics, the proposed ventilatory strategies and the correct positioning of critically ill adult patients with HIA and ACS with the requirement of IMV in the ICU. Data sources: the bibliographic search was carried out in Pubmed, Cochrane Libr...

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Detalles Bibliográficos
Autores principales: Vicente, Antonela, Virgilio, Sacha Alexis, Tocalini, Pablo, Novo, María Noel
Formato: Artículo revista
Lenguaje:Español
Publicado: Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2020
Materias:
intra-abdominal hypertension
respiration, artificial
respiratory mechanics
intensive care units
hipertensión intra-abdominal
respiración artificial
mecánica respiratoria
unidades de cuidados intensivos
hipertensão intra-abdominal
respiração artificial
mecânica respiratória
unidades de terapia intensiva
Acceso en línea:https://revistas.unc.edu.ar/index.php/med/article/view/28148
Aporte de:
Revista de la Facultad de Ciencias Médicas de Córdoba de Universidad Nacional de Córdoba
Descripción
Sumario:Objective: to describe the modifications in respiratory mechanics, the proposed ventilatory strategies and the correct positioning of critically ill adult patients with HIA and ACS with the requirement of IMV in the ICU. Data sources: the bibliographic search was carried out in Pubmed, Cochrane Library and Google Scholar® without restriction of the language with publication date until July 31, 2019. Study selection: adult patients with a requirement for IMV and diagnosis of HIA and / or ACS who have performed the ventilatory monitoring and patient positioning analysis. Laboratory studies on animals will be excluded. Data extraction: the initial search identified 681 studies, of which 30 articles were included for data analysis. Synthesis of data: patients with VMI requirement should be allowed to increase airway pressures and use of high PEEP; Only in specific cases could recruitment and prone maneuvering be applied to maintain adequate alveolar ventilation. Inverted Trendelemburg positioning is useful, as it improves respiratory mechanics and prevents abdominal compression. Conclusions: alterations in respiratory mechanics produce a decrease in thoracic compliance, lung volumes and oxygenation disorders. The ventilatory strategy should consider Vt between 6-8 ml / kg according to predicted body weight, working pressure less than 14 cm H2O, plateau pressure of 30 cm H2O + PIA / 2 and sufficient levels of PEEP to prevent lung collapse in order to expiration.

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