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Ventilación mecánica intraoperatoria. Camilo Ernesto Argoty Inca Residente Anestesiología Universidad del Valle . Contenido . Inicios de ventilación asistida. Métodos iniciales. El “Pulmotor”. Heinrich Dr ӓ ger , 1900. Respirador Emerson. “ Iron lung ”. Jhon Haven Emerson - 1931.
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Ventilación mecánica intraoperatoria Camilo Ernesto Argoty Inca Residente Anestesiología Universidad del Valle
El “Pulmotor” Heinrich Drӓger, 1900
Respirador Emerson • “Ironlung” • Jhon Haven Emerson - 1931
Ventiladores de presión positiva BjørnIbsen V. Ray Bennett
¿Son relevantes? B. Kilpatrick, P. Slinger. Lung protective strategies in anaesthesia British Journal of Anaesthesia 105 (S1): i108–i116 (2010)
¿Son relevantes? • Muestra: 2005 a 2009 • Gasometría intraoperatoria BlumJM, Maile M, Park PK, Morris M, Jewell E, Dechert R, Rosenberg AL. A Description of IntraoperativeVentilator Management in PatientswithAcuteLungInjury and the Use of LungProtectiveVentilationStrategies. Anesthesiology. 2011 Jul;115(1):75-82.
¿Son relevantes? Blum JM, Maile M, Park PK, Morris M, Jewell E, Dechert R, RosenbergAL. A Description of IntraoperativeVentilator Management in PatientswithAcuteLungInjury and the Use of LungProtectiveVentilationStrategies.Anesthesiology. 2011 Jul;115(1):75-82.
Desenlaces en anestesia Michelet P, D’Journo X-B, Roch A et al. Protectiveventilationinfluencessystemicinflammationafteresophagectomy. Anesthesiology 2006; 105: 911–919
Desenlaces en anestesia Tat: complejos trombina antitrombina Stf: factor tisular soluble ChoiG,Wolthuis EK, Bresser P et al. Mechanicalventilationwithlowertidalvolumes and positive end- expiratorypressureprevents alveolar coagulation in patientswithoutlunginjury. Anesthesiology2006; 105: 689–695
Atelectasias y PEEP Ralph Gertler, Girish P. Joshi. Modern Understanding of Intraoperative Mechanical Ventilation in Normal and Diseased Lungs Advances in Anesthesia 28 (2010) 15–33
Atelectasias y PEEP HeshamF. Talab, MD, et al. IntraoperativeVentilatoryStrategiesforPreventionof PulmonaryAtelectasis in ObesePatientsUndergoingLaparoscopicBariatricSurgery. Anesthesia & analgesia Vol. 109, No. 5, November 2009
Atelectasias y PEEP HenrikReinius, M.D. , et al. Preventionof Atelectasis in MorbidlyObesePatientsduringGeneral Anesthesia and Paralysis A ComputerizedTomographyStudy. Anesthesiology 2009; 111:979–87
Desenlaces en anestesia Imberger G, McIlroy D, Pace NL, Wetterslev J, Brok J, Møller AM. Positive end-expiratorypressure (PEEP) duringanaesthesiafortheprevention of mortality and postoperativepulmonarycomplications. Cochrane Database of SystematicReviews2010, Issue9. Art. No.: CD007922.
Maniobras de reclutamiento • Maniobras CPAP • Maniobras cíclicas: • Estrategia de reclutamiento alveolar
Comparativa Volumen control Presión control
Ventilación unipulmonar • n: 48 • Vt: 10 ml/kg M Tuğrul, E Camci, H Karadeniz, M Sentürk, K Pembeci, and K AkpirComparisonof volumecontrolledwithpressurecontrolledventilationduringone-lunganaesthesia. Br. J. Anaesth. (1997) 79(3): 306-310
Ventilación unipulmonar HeimbergC, Winterhalter M, Strüber M, Piepenbrock S, Bund M. Pressure-controlledversus volume-controlledone-lungventilationfor MIDCAB. ThoracCardiovascSurg. 2006 Dec;54(8):516-20
Ventilación unipulmonar Montes FR, Pardo DF, Charrís H, Tellez LJ, Garzón JC, Osorio C. Comparisonof twoprotectivelungventilatoryregimesonoxygenationduringone-lungventilation: a randomizedcontrolled trial. J CardiothoracSurg. 2010 Nov 2;5:99.
Ventilación en obesos • n: 36 • IMC > 35 • Laparoscopia Cadi P, Guenoun T, Journois D, Chevallier JM, Diehl JL, SafranD. Pressure-controlledventilationimprovesoxygenationduringlaparoscopicobesitysurgerycomparedwithvolume-controlledventilation. Br J Anaesth. 2008 May;100(5):709-16.
Ventilación en obesos ObesitySurgery, 2008