Nueva evidencia en ventilación unipulmonar

Meleiro, Hugo; Correia, I.; Mora, Pedro Charco

doi:10.1016/j.redar.2017.06.007

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…La asociación con ciclos de reclutamiento alveolar, provocaría menos estrés pulmonar con mejor oxigenación, mayor compliance y descenso del espacio muerto. Si bien no está establecido el número óptimo de maniobras de reclutamiento alveolar, se recomienda realizar un reclutamiento alveolar al inicio y uno luego de la reexpansión del pulmón no ventilado [15].…”

Section: Discussionunclassified

Esofagectomía minimamente invasiva

Saxlund¹,

Gastelú²

2021

Rev. chil. anest.

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Introduction: Minimally invasive esophagectomy aims to reduce complications compared to open esophagectomy. In this report of the first patient undergoing this procedure at Hospital Pasteur, we highlight the importance of multidisciplinary management, and the main anesthesiological objectives. Objective: To present the case report highlighting the anesthetic management, together with the bibliographic review carried out in order to update the anesthetic action protocols, with the main objective of reducing the appearance of perioperative complications. Material and Method: Bibliographic search in PubMed bibliographic databases. Initially, 67 articles were obtained, selecting 20 considered relevant by the authors. Clinical case: It was a 46-year-old patient coordinated for esophagectomy for squamous neoplasm. Rapid sequence induction, selective endobronchial intubation and anesthetic maintenance with Isoflurane and epidural analgesia were performed. The hydroelectric replacement was restrictive. The surgical technique was performed in 3 stages: thoracic time by thoracoscopy; a second laparoscopic abdominal stage and a third stage for left cervicotomy. Extubation was carried out in the operating room with transfer to the ICU where she remained for 6 days to manage analgesia and due to the presence of a mild infectious complication, with good subsequent evolution. Conclusion:The use of perioperative multidisciplinary management protocols has fundamental importance as a strategy aimed at reducing morbidity and mortality. Advances in surgical technique added to anesthetic management constitute strategies that aim to reduce perioperative complications.

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Section: Discussionunclassified

Esofagectomía minimamente invasiva

Saxlund¹,

Gastelú²

2021

Rev. chil. anest.

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“…Furthermore, the Italian and Japanese anesthesiologists recommend a lower tidal volume (4–6 ml/kg PBW) for OLV [ 1 , 22 ]. Nevertheless, opinions from the expert anesthesiologists highlight that protective ventilation in thoracic anesthesia is not simply synonymous of a low tidal volume, but also involves the appropriate application of PEEP, alveolar recruitment and other ventilatory settings during OLV [ 23 , 24 ]. Most recently, a double-blind, randomized controlled trial conducted at the Samsung Medical Center (Seoul, Korea) demonstrated that driving pressure-guided ventilation (median ∆P of 9 cmH 2 O) during OLV significantly reduced the incidence of postoperative pulmonary complications compared with the conventional protective ventilation (tidal volume 6 ml/kg PBW, PEEP 5 cmH 2 O and recruitment) in thoracic surgery [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

et al. 2020

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Background There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan. Methods This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV. Results A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6–7 ml/kg PBW (67.6%) and a PEEP level of 4–6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 > 0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established. Conclusions This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

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“…La hipercapnia, es la consecuencia del descenso en la ventilación alveolar [15] produce trastornos hemodinámicos a nivel cardiovascular, cerebrovascular y pulmonar [14]. Su causa podría estar relacionada a fenómenos fisiopatológicos que desencadenan incremento de CO 2 exhalado [6], [11], [17] El desarrollo de patologías que condicionan el incremento del espacio muerto debido a trastornos de ventilación y perfusión [4], [17], [21], se están volviendo cada vez más frecuentes, ya sea por obesidad, enfermos pulmonares crónicos o patologías que implican traumas torácicos. La fisiopatología se explica por el trastorno pulmonar acompañada de hipoventilación, ocasiona que disminuya la presión alveolar de oxígeno (PAO 2 ) y presión arterial de oxigeno (PaO 2 ) con retención de CO 2 secundaria, este incremento de CO 2 y trastornos V/Q, produce iones H que incrementa la PaCO 2 volviendo los mecanismos compensatorios a la hipercapnia menos susceptible [9], [14], [18], [19].…”

Section: Discussionunclassified

“…La fisiopatología se explica por el trastorno pulmonar acompañada de hipoventilación, ocasiona que disminuya la presión alveolar de oxígeno (PAO 2 ) y presión arterial de oxigeno (PaO 2 ) con retención de CO 2 secundaria, este incremento de CO 2 y trastornos V/Q, produce iones H que incrementa la PaCO 2 volviendo los mecanismos compensatorios a la hipercapnia menos susceptible [9], [14], [18], [19]. En estos pacientes el abordaje de ventilación mecánica, para protección pulmonar, acepta un aumento de CO 2 exhalado hasta 45 mmHg, el objetivo, minimizar la lesión pulmonar inducida por el ventilador, el mecanismo es útil en paciente enfermos crónicos, no está clara la asociación en trauma torácico, pero podría beneficiarse, siempre con un monitoreo de microdinamia, control de gases arteriales y prevención del desarrollo de acidosis hipercápnica [9], [11], [12], [19].…”

Section: Discussionunclassified

Consideraciones anestésicas en hipercapnia intraoperatoria, a propósito de un caso

Pila¹,

Aguilar²

2019

Rev. chil. anest.

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Nueva evidencia en ventilación unipulmonar

Cited by 6 publications

References 20 publications

Esofagectomía minimamente invasiva

Esofagectomía minimamente invasiva

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

Consideraciones anestésicas en hipercapnia intraoperatoria, a propósito de un caso

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