Mecánica respiratoria en anestesia general: Revisión de conceptos

Placenti, Alejandro; Ramos, Matías; Fratebianchi, Franco

doi:10.25237/revchilanestv5130121222

Cited by 1 publication

(4 citation statements)

References 35 publications

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“…For example, during volume-controlled ventilation, once V T and inspiratory time were established, P aw peak – P aw plateau generated will depend on the airway resistance value. That is to say, in the face of an increase in resistance such as endotracheal tube kinking, secretions, bronchospasm, etc., the pressure difference between the P aw peak and P aw plateau will increase by increasing the P aw peak [ 31 ].…”

Section: Protective Ventilation Parametersmentioning

confidence: 99%

“…For example, during volume-controlled ventilation, once V T is established, the decrease in inspiratory time (by decreasing the I : E ratio from 1 : 2 to 1 : 4, increasing the respiratory rate or increasing the inspiratory pause time in anaesthesia ventilators) will generate an increase in inspiratory flow (ΔV) and this will determine an increase in P aw peak , thus increasing the pressure difference between P aw peak and P aw plateau [ 31 ].…”

Section: Protective Ventilation Parametersmentioning

confidence: 99%

“…ΔP es ) (represented in green), without haemodynamic repercussions. Actually, the risks of mechanical ventilation in patients ventilated with similarly high airway pressures range from the risk of lung damage if the lung elastance is high and the chest wall elastance is low, and haemodynamic instability in the opposite situation [ 3 , 31 ]. Where P aw plateau is airway plateau pressure, PEEP is positive end expiratory pressure, ΔP aw is airway driving pressure, P L PEEP is transpulmonary pressure at end of expiration, ΔP L is transpulmonary driving pressure o lung driving pressure, ΔP es is oesophageal driving pressure or driving pressure across the chest wall (ΔP cw ) or the change in pleural pressure between the end of inspiration and the end of expiration (ΔP pl ), PL plateau is transpulmonary pressure at the end of inspiration, P es plateau is oesophageal pressure at the end of inspiration, and P es PEEP is oesophageal pressure at the end of expiration.…”

Section: Protective Ventilation Parametersmentioning

confidence: 99%

“… Determinants of protective ventilation parameters. Where P aw plateau is airway plateau pressure, V T is tidal volume, PEEP volume is volume generated by PEEP, E rs is respiratory system elastance, E L is lung elastance, E cw is chest wall elastance, P L plateau is transpulmonary pressure at the end of inspiration, P es plateau is oesophageal pressure at the end of inspiration, P L PEEP is transpulmonary pressure at end of expiration, ΔP L is transpulmonary driving pressure or lung driving pressure, ΔP es is oesophageal driving pressure or driving pressure across the chest wall (ΔP cw ) or the change in pleural pressure between the end of inspiration and the end of expiration (ΔP pl ), P es PEEP is oesophageal pressure at the end of expiration, and ΔP aw is airway driving pressure or respiratory system driving pressure (ΔP rs ) [ 31 ] …”

Section: Protective Ventilation Parametersmentioning

confidence: 99%

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Interpretation and use of intraoperative protective ventilation parameters: a scoping review

Placenti¹,

Fratebianchi²

2022

ait

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Thirty years ago, the traditional approach to mechanical ventilation consisted of the normalization of PaCO 2 and pH at the expense of using a tidal volume (V T ) of 10-15 mL kg -1 . But then, the use of 6-8 mL kg -1 became a dogma for ventilating patients either with acute respiratory distress syndrome (ARDS) or without lung disease in the operating theatre. It is currently recognized that even low tidal volumes may be excessive for some patients and insufficient for others, depending on its distribution in the aerated lung parenchyma. To carry out intraoperative protective mechanical ventilation, medical literature has focused on positive end expiratory pressure (PEEP), plateau pressure (P aw plateau ), and airway driving pressure (ΔP aw ). However, considering its limitations, other parameters have emerged that represent a better reflection of isolated lung stress, such as transpulmonary pressure (P L ) and transpulmonary driving pressure (ΔP L ). These parameters are less generalized in clinical practice due to the requirement of an oesophageal balloon for their measurement and therefore their cumbersome application in the operating theatre. However, its study helps in the interpretation of the rest of the ventilator pressures to optimize intraoperative mechanical ventilation. This article defines and develops protective ventilation parameters, breaks down their determinants, mentions their limitations, and offers recommendations for their use intraoperatively.

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Section: Protective Ventilation Parametersmentioning

confidence: 99%

Section: Protective Ventilation Parametersmentioning

confidence: 99%