Manobra de recrutamento alveolar em anestesia: como, quando e por que utilizá-la

Abstract

RESUMO

Manobra de recrutamento alveolar na contusão pulmonar: relato de caso e revisão da literatura

“…(18) ARM is a technique using the sustained increase of pressure in the airway for the purpose of recruiting collapsed alveolar units increasing the pulmonary area available for gas exchange and, therefore arterial oxygenation. There are different ways to carry out alveolar recruitment maneuvers, but use of the "ideal" PEEP achieved with 2.0 cm of H 2 O above the lower point of inflection of the pressure x volume curve maintains the lung only partially open.…”

Recrutamento alveolar em pacientes no pós-operatório imediato de cirurgia cardíaca

“…They are defined as procedures that are intended to increase transpulmonary pressure in order to promote the opening of the largest possible number of alveoli and then improve the distribution of alveolar gas [10,11]. Therefore, this approach maximizes gas exchange, improves arterial oxygenation and reduces lung lesions induced by mechanical ventilation, known as volutrauma, atelectrauma and biotrauma [19].…”

“…Different methods are proposed for the realization of alveolar recruitment, such as: inflation sustained with high levels of continuous positive airway pressure (CPAP), a simultaneous increase of positive end-expiratory pressure (PEEP) and tidal volume (TV); progressive increase of PEEP with a fixed value of inspiratory pressure (IP) and simultaneous increase of inspiratory pressure (IP) and PEEP in pressure controlled ventilation mode [11,13,22].…”

Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo

“…(9)(10)(11)(12) The objective is to improve gas exchange by maximum recruitment of alveolar units, to provide a more homogeneous pulmonary parenchyma ventilation. (5) According to the 3 rd Brazilian Consensus on Mechanical Ventilation, ARM has a recommendation level B for ALI/ARDS patients, as there is no consensual opinion on how to perform this maneuver. (7) According to the experts involved in the 3 rd Consensus, there is not enough data to identify effects on morbidity and mortality for patients under pressure controlled (PCV) or volume controlled ventilation (CVV).…”

“…The first uses sustained increased airway pressure for recruitment of collapsed alveolar units, thus increasing the lung area available for gas exchange and, consequently, arterial oxygenation. (5,6) The second may be considered for patients who need increased positive endexpiratory pressure (PEEP) and FiO 2 in order to keep appropriate oxygen saturation (SaO 2 ), or patients with acute lung injury (ALI)/severe ARDS, except for those of r high risk of adverse consequences related to posture changes or patients quickly improving. (7) A literature review was performed, searching books in private collections, and databases MedLine, LI-LACS, SciElo, PubMed, Cochrane, from 1994 to 2008 in Portuguese and English using the key words: acute respiratory distress syndrome, alveolar recruitment maneuver and prone position.…”