Ventilação mecânica protetora: revisão de ensaios clínicos randomizados

  • Bruno Valle Pinheiro Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Juiz de Fora
  • Cristiane Bastos Netto Unidade de Cuidados Intensivos do Hospital Universitário, Universidade Federal de Juiz de Fora
  • Rodrigo Souza Vieira Unidade de Cuidados Intensivos do Hospital Universitário, Universidade Federal de Juiz de Fora
  • Mateus Pinto Botelho Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Juiz de Fora
  • Gabrielli Moura Lopes Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Juiz de Fora
  • Maycon Moura Reboredo Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Juiz de Fora
Palavras-chave: Respiração Artificial, Lesão Pulmonar, Mortalidade

Resumo

Introdução: A ventilação mecânica pode ser uma estratégia salvadora de vidas em pacientes com insuficiência respiratória. Porém, ela é potencialmente perigosa e pode causar a chamada lesão pulmonar induzida pela ventilação mecânica (VILI). Esta revisão objetivou analisar os resultados de ensaios clínicos randomizados (ECR) que avaliaram o impacto de ajustes ventilatórios sobre a mortalidade. Material e métodos: Buscou-se, na base PubMed ECR, artigos publicados entre 1980 e 2019, usando os seguintes termos MeSH: “respiratory distress syndrome, adult” and “respiration, artificial”. Selecionou-se os ECR que compararam diferentes parâmetros ventilatórios e que tiveram a mortalidade como desfecho. Resultados: Em pacientes com síndrome do desconforto respiratório agudo (SDRA), demonstrou-se que a limitações do volume corrente, da pressão de platô e da pressão de distensão reduzem a mortalidade. Na SDRA grave, o uso de pressão expiratória final positiva (PEEP) mais alta e a posição prona também reduzem a mortalidade. Entre pacientes sem SDRA, ainda é incerto se alguma dessas estratégias associa-se a melhor sobrevida. Conclusão: Em pacientes com SDRA, deve-se estar atento para o ajuste da ventilação mecânica, pois parâmetros protetores podem aumentar a sobrevida.

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Publicado
2019-11-28
Como Citar
Valle Pinheiro, B., Bastos Netto, C., Souza Vieira, R., Pinto Botelho, M., Moura Lopes, G., & Moura Reboredo, M. (2019). Ventilação mecânica protetora: revisão de ensaios clínicos randomizados. HU Revista, 45(3), 334-340. https://doi.org/10.34019/1982-8047.2019.v45.28988
Seção
Artigos de Revisão da Literatura