Pressão expiratória final positiva aumenta o estiramento em pacientes com LPA/SDRA

Abstract

Objective: The objective of this study was to assess the effects of positive endexpiratory pressure on recruitment, cyclic recruitment and derecruitment and strain in patients with acute lung injury and acute respiratory distress syndrome using lung computed tomography. Methods: This is an open, controlled, non-randomized interventional study of ten patients with acute lung injury and acute respiratory distress syndrome. Using computed tomography, single, basal slices of the lung were obtained during inspiratory and expiratory pauses at a tidal volume of 6 ml/kg and a positive end-expiratory pressure of 5, 10, 15 and 20 cmH2O. The densities of the lung parenchyma were measured in Hounsfield units. The values for positive endexpiratory pressure-induced recruitment, cyclic recruitment and derecruitment and strain were then calculated. Results: Increasing levels of positive end-expiratory pressure were correlated with increased recruitment and global strain (p < 0.01), which was significantly correlated with plateau pressure (r 2 = 0.97, p < 0.01). In addition, increasing levels of positive end-expiratory pressure systematically increased strain along the sternovertebral axis. Conclusion: While strain is an adverse effect of positive end-expiratory pressure, the decision use positive endexpiratory pressure with any patient should be balanced against the potential benefits of recruitment. Due to the small number of patients in this study, the present data should be treated as hypothesis generating and is not intended to limit the clinical application of a high level of positive end-expiratory pressure in patients with severe hypoxemia.

Ventilação protetora na síndrome do desconforto respiratório agudo causada pela COVID-19: o manejo do fisioterapeuta

“…Entretanto, apesar de ser imprescindível para a manutenção da vida em determinadas situações, a VMI poderá causar Lesão Pulmonar Induzida por Ventilador Mecânico (LPIV), que leva a repercussões clínicas e histopatológicas 5 . Dessa forma, a utilização da ventilação protetora se torna benéfica devido à diminuição do estresse e do estiramento, secundária ao uso de baixos volumes correntes e, consequentemente, do estiramento cíclico, em um pulmão grandemente heterogêneo 6 .…”