entendendo os mecanismos determinantes da lesão pulmonar induzida pela ventilação mecânica understanding the mechanisms of ventilator-induced lung injury

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ID: 249317
2007
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Abstract
JUSTIFICATIVA E OBJETIVOS: A ventilação mecânica é considerada elemento básico de suporte de vida nas unidades de terapia intensiva e, indubitavelmente, essencial para os pacientes com lesão pulmonar aguda (LPA) e síndrome do desconforto respiratório agudo (SDRA). Estudos experimentais demonstraram que a ventilação mecânica (VM) com altos volumes e/ou altas pressões pode exacerbar ou iniciar uma lesão pulmonar, denominada lesão pulmonar associada à VM (LPAV) ou lesão pulmonar induzida pelo ventilador (LPIV), respectivamente, com aspecto histológico similar ao da LPA/SDRA. CONTEÚDO: Realizou-se uma pesquisa sistemática dos artigos incluídos na MedLine e SciElo dos últimos 20 anos, que abordavam uma visão crítica dos principais mecanismos determinantes da LPIV. Dentre os principais mecanismos da LPAV/LPIV pode-se citar: volutrauma causado por hiperdistensão e expansão desigual das unidades alveolares em função de altas pressões transpulmonares ou volumes; aletectrauma resultante da abertura e fechamento cíclicos das vias aéreas distais e o biotrauma determinado pelo processo inflamatório conseqüente às estratégias ventilatórias lesivas adotadas. CONCLUSÕES: Os mecanismos responsáveis pelo volutrauma, atelectrauma e biotrauma devem ser bem entendidos para que se possa evitar a lesão associada à ventilação mecânica.
BACKGROUND AND OBJECTIVES: Mechanical ventilation is considered a basic element of life support in the intensive care unit and is essential for patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Experimental studies have demonstrated that mechanical ventilation with high volumes and/or high pressures can exacerbate (VALI) or induce lung injury (VILI) with histological aspect similar to ALI/ARDS. CONTENTS: This systematic review included the literature on MedLine and SciElo database published in the last 20 years. In this review, we will highlight the most recent data on the mechanisms of VILI. The main mechanisms of VILI are: volutrauma caused by overinflation and uneven expansion of the lungs due to high ventilation pressures or volumes; aletectrauma induced by shear forces generated during cyclic closure and reopening of terminal airways; and biotrauma where the injury resulted from the release inflammatory mediators due to physical stresses associated with mechanical ventilation. CONCLUSIONS: It is fundamental to understand the mechanisms related to volutrauma, atelectrauma, and biotrauma to avoid ventilator-associated lung injury.
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nardelli2007revistaentendendo Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Liliane M. Nardelli;Cristiane S. N. B. Garcia;Caroline P Pássaro;Patricia R. M. Rocco
Journal Database : the journal of biological databases and curation
Year 2007
DOI
10.1590/S0103-507X2007000400011
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2007000400011
Keywords
acute lung injury ards critical care first aid intensive care

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