2008
DOI: 10.1590/s0034-70942008000100011
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Atelectasias durante anestesia: fisiopatologia e tratamento

Abstract: Rev Bras AnestesiolARTIGO DE REVISÃO 2008; 58: 1: 73-83 REVIEW ARTICLE RESUMOMalbouisson LMS, Humberto F, Rodrigues RR, Carmona MJC, Auler Jr JOC -Atelectasias durante Anestesia: Fisiopatologia e Tratamento. JUSTIFICATIVA E OBJETIVOS:O colapso pulmonar intra-operatório é uma complicação de elevada incidência em pacientes submetidos à intervenção cirúrgica sob anestesia geral com relaxamento/paralisia da musculatura. Essa complicação está associada à piora das trocas gasosas no intra-operatório e, em alguns … Show more

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Cited by 36 publications
(43 citation statements)
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“…In this case, the limit was 40 cm of water, a perfectly safe value for a healthy lung. It is possible that obstruction of left bronchus by presence of secretion had caused absorption of alveoli oxygen in this lung, not allowing the entrance of fresh gases, causing atelectasis zones 15 , and leading to progressive saturation drop until the observed value around 90%. Capnography showed values around 30 mmHg, suggesting hyperventilation.…”
Section: Discussionmentioning
confidence: 98%
“…In this case, the limit was 40 cm of water, a perfectly safe value for a healthy lung. It is possible that obstruction of left bronchus by presence of secretion had caused absorption of alveoli oxygen in this lung, not allowing the entrance of fresh gases, causing atelectasis zones 15 , and leading to progressive saturation drop until the observed value around 90%. Capnography showed values around 30 mmHg, suggesting hyperventilation.…”
Section: Discussionmentioning
confidence: 98%
“…These results (oxygenation) are in agreement with data published in the literature 4 . Other pulmonary recruitment protocols have been described by several authors to revert atelectasis 13,14 . Among them, the use of consecutive and sustained hyperinsufflations with high inspiratory pressure (40 cmH 2 O) or increasing PEEP (Positive end-expiratory pressure) up to 15 cmH 2 O.…”
Section: Discussionmentioning
confidence: 99%
“…Since perfusion remains unaltered, an imbalance occurs in the ventilation/perfusion ratio (V/Q ratio), resulting in arterial hypoxemia 4,7,8,11 . To reverse this situation or to prevent the development of atelectasis in patients receiving mechanical ventilation, re-expansion techniques such as manual hyperinsuflation 2,12 , high airway pressure 13,14 , bronchoscopy 1 and manual chest compression and decompression had been used 15 . Manual chest compression and decompression maneuver (MCCD) is carried out in the intensive care unit exclusively by physical therapists.…”
Section: Introductionmentioning
confidence: 99%
“…Apesar da elevada FiO 2 otimizar a oxigenação arterial e evitar a hipoxemia temporariamente, também pode aumentar os shunts intrapulmonares, pois a alta concentração de oxigênio no ar inspirado é rapidamente absorvida pelos capilares sanguíneos pulmonares, resultando em colapso alveolar. Os desequilíbrios da relação V/Q formados durante a anestesia frequentemente persistem no período pós-operatório imediato, sendo que a P(A-a)O 2 pode permanecer aumentada e a relação PaO 2 /FiO 2 e a PaO 2 diminuídas (HALL et al, 1968;MASON et al, 1987;McMURPHY;CRIBB, 1989;WHITEHAIR et al, 1993;DAY et al, 1995;SANTOS et al, 2003;MARNTELL et al, 2005;MALBOUISSON et al, 2008).…”
Section: Revisão De Literaturaunclassified
“…. Entretanto, durante a anestesia, a instituição de altas concentrações de oxigênio no ar inspirado está associada à maior P(A-a)O 2 , atribuída à formação mais rápida de atelectasias e à maior quantidade de shunts intrapulmonares quando comparada ao uso de FiO 2 menores (CUVELLIEZ et al, 1990;MARNTELL et al, 2005;MALBOUISSON et al, 2008). Isso porque a composição do ar inspirado é capaz de interferir na habilidade do alvéolo em permanecer aberto, uma vez que altas concentrações de oxigênio inspirado são absorvidas mais rapidamente pelos capilares pulmonares, resultando em colapso alveolar.…”
Section: Grupo Psvunclassified