Ventilação mecânica protetora: revisão de ensaios clínicos randomizados

Autores

  • 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
  • Gabrielle de 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

DOI:

https://doi.org/10.34019/1982-8047.2019.v45.28988

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.

Downloads

Não há dados estatísticos.

Referências

Esteban A, Anzueto A, Frutos-Vivar F, Alía A, Brochard L, Stewart TE et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002; 287(3):345-55.

Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L et al. Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med. 2008; 177(2):170-7.

Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Peñuelas O, Abraira V et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med. 2013; 188(2):220-30.

D’Avignon P, Hedenström G, Hedman C. Pulmonary complications in respirator patients. Acta Med Scand. 1956; 154(316 S):86-90.

Fuhrman TM, Gammon RB, Shin MS, Buchalter SE. Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors. Chest. 1992; 102(102):568-72.

Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013; 369(22):2126-36.

Santos C, Slutsky A. Invited review: mechanisms of ventilator-induced lung injury: a perspective. J Appl Physiol. 2000; 89(4):1645-55.

Webb HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end expiratory pressure. Am Rev Respir Dis. 1974; 110(5):556-65.

Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis. 1988; 137(5):1159-64.

Gattinoni L, Marini JJ, Pesenti A, Quintel M, Mancebo J, Brochard L. The “baby lung” became an adult. Intensive Care Med. 2016; 42(5):663-73.

Slutsky A. Ventilator-induced injury: from barotrauma to biotrauma. Proc Assoc Am Physicians. 1998; 110(6):482-8.

Amato MBP, Barbas CSV, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998; 338(6):347-54.

Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342(18):1301-8.

Stewart TE, Meade MO, Cook DJ, Granton JT, Hodder RV, Lapinsky SE et al. Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. N Engl J Med. 1998; 338(6):355-61.

Brochard L, Roudot-Thoraval F, Roupie E, Delclaux C, Chastre J, Fernandez-Mondéjar E et al. Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. Am J Respir Crit Care Med. 1998; 158(6):1831-8.

Brower RG, Shanholtz CB, Fessler HE, Shade DM, White P Jr, Wiener CM et al. Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med. 1999; 27(8):1492-8.

Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of critical care medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017; 195(9):1253-63.

Terragni PP, Rosboch G, Tealdi A, Corno E, Menaldo E, Davini O et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2007; 175(2):160-6.

Bugedo G, Retamal J, Bruhn A. Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation? Crit Care. 2017; 21(1):199.

Amato MBP, Meade MO, Slutsky AS, Brochard L, Costa ELV, Schoenfeld DA et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015; 372(8):747-55.

Villar J, Martín-Rodríguez C, Domínguez-Berrot AM, Fernández L, Ferrando C, Soler JÁ et al. A quantile analysis of plateau and driving pressures: effects on mortality in patients with acute respiratory distress syndrome receiving lung-protective ventilation. Crit Care Med. 2017; 45(5):843-50.

Guérin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel JM. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care. 2016; 20(1):384.

Brower RG, Lanken PN, Maclntyre N, Matthay MA, Morris A, Ancukiewicz M et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004; 351(4):327-36.

Meade M, Cook DJ, Arabi YM, Cooper DJ, Davies AR, Hand LE et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008; 299:637-45.

Mercat A, Richard JCM, Vielle B, Jaber S, Osman D, Diehl JL et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008; 299:646-55.

Briel M, Meade M, Mercat A. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010; 303(9):865-73.

Santos RS, Silva PL, Pelosi P, Rocco PR. Recruitment maneuvers in acute respiratory distress syndrome: the safe way is the best way. World J Crit Care Med. 2015; 4(4):278-86.

Silva PL, Pelosi P, Rocco PR. Recruitment maneuvers for acute respiratory distress syndrome: the panorama in 2016. Rev Bras Ter Intensiva. 2016; 28(2):104-6.

Del Sorbo L, Tonetti T, Ranieri VM. Alveolar recruitment in acute respiratory distress syndrome: should we open the lung (no matter what) or may accept (part of) the lung closed? Intensive Care Med. 2019; 45(10):1436-9.

Cavalcanti AB, Suzumura ÉA, Laranjeira LN, Paisani DM, Damianni LP, Guimarães HP et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2017; 318(14):1335-45.

Goligher EC, Hodgson CL, Adhikari NKJ, Meade MO, Wunsch H, Uleryk E et al. Lung recruitment maneuvers for adult patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Ann Am Thorac Soc. 2017; 14(Suppl 4):S304-11.

Lu J, Wang X, Chen M, Cheng L, Chen Q, Jiang H et al. An open lung strategy in the management of acute respiratory distress syndrome: a systematic review and meta-analysis. Shock. 2017; 48(1):43-53.

Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone position in acute respiratory distress syndrome: rationale, indications, and limits. Am J Respir Crit Care Med. 2013; 188(11):1286-93.

Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO et al. Prone position for acute respiratory distress syndrome: a systematic review and meta-analysis. Ann Am Thorac Soc. 2017; 14(Suppl 4):S280-8.

Kamo T, Aoki Y, Fukuda T, Kurahashi K, Yasuda H, Sanui M et al. Optimal duration of prone positioning in patients with acute respiratory distress syndrome: a protocol for a systematic review and meta-regression analysis. BMJ Open. 2018; 8(9):e021408.

Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368(23):2159-68.

Determann RM, Royakkers A, Wolthuis EK, Vlaar AP, Choi G, Paulus F et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care. 2010; 14(1):R1.

Simonis FD, Serpa Neto A, Binnekade JM, Braber A, Bruin KCM, Determann RM et al. Effect of a low vs intermediate tidal volume strategy on ventilator-free days in intensive care unit patients without ARDS: a randomized clinical trial. JAMA. 2018; 320(18):1872-80.

Neto AS, Hemmes SNT, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016; 4(4):272-80.

Simonis FD, Barbas CSV, Artigas-Raventos A, Canet J, Determann RM, Anstey J et al. Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT. Ann Intensive Care. 2018; 8(1):39.

Downloads

Publicado

2019-11-28

Como Citar

1.
Valle Pinheiro B, Bastos Netto C, Souza Vieira R, Pinto Botelho M, de Moura Lopes G, Moura Reboredo M. Ventilação mecânica protetora: revisão de ensaios clínicos randomizados. HU Rev [Internet]. 28º de novembro de 2019 [citado 29º de março de 2024];45(3):334-40. Disponível em: https://periodicos.ufjf.br/index.php/hurevista/article/view/28988

Edição

Seção

Artigos de Revisão da Literatura

Artigos mais lidos pelo mesmo(s) autor(es)