Manobra de recrutamento alveolar em anestesia: como, quando e por que utilizá-la

Luciana Oliveira Gonçalves; Domingos Dias Cicarelli

doi:10.1590/S0034-70942005000600006

Scientific Article

Manobra de recrutamento alveolar em anestesia: como, quando e por que utilizá-la

Alveolar recruitment maneuver in anesthetic practice: how, when and why it may be useful

Luciana Oliveira Gonçalves; Domingos Dias Cicarelli

http://dx.doi.org/10.1590/S0034-70942005000600006 Braz J Anesthesiol, vol.55, n6, p.631-638, 2005

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JUSTIFICATIVA E OBJETIVOS: A manobra de recrutamento alveolar (MRA) consiste na reabertura de áreas pulmonares colapsadas através do aumento da pressão inspiratória na via aérea, utilizada principalmente em pacientes com Síndrome do Desconforto Respiratório Agudo. O objetivo deste estudo foi avaliar a aplicação da MRA em anestesia, como realizá-la e em quais situações clínicas. MÉTODO: Revisão de literatura através da base de dados MedLine, no período compreendido entre 1993 e 2004. RESULTADOS: A forma mais utilizada para realização da MRA é a insuflação sustentada pelo modo CPAP com pressões que variam de 30 a 40 cmH2O por 30 a 90 segundos. As cirurgias laparoscópicas, as cirurgias com ventilação monopulmonar, cirurgias cardíacas, pacientes obesos e pacientes pediátricos foram as situações clínicas em que a MRA trouxe benefício aos pacientes. CONCLUSÕES: A MRA pode ser útil na prática anestésica, melhorando a oxigenação pós-operatória e desfazendo atelectasias de pacientes submetidos à anestesia geral.

Palavras-chave

ANESTESIA, COMPLICAÇÕES, PEEP, VENTILAÇÃO MECÂNICA

Abstract

BACKGROUND AND OBJECTIVES: Alveolar recruitment maneuver (ARM) is the reopening of lung tissue collapsed by increased airway inspiratory pressure, primarily performed in patients with acute respiratory distress syndrome. This study aimed at evaluating ARM in anesthesia, how to do it and in which clinical situations. METHODS: Literature review using MedLine database in the period 1993 to 2004. RESULTS: Most common approach for recruitment maneuver is sustained inflation by CPAP with pressures varying from 30 to 40 cmH2O for 30 to 90 seconds. ARM was beneficial during laparoscopic procedures, single-lung ventilation surgeries and cardiac surgeries, and for obese and pediatric patients. CONCLUSIONS: Recruitment maneuver may be useful for anesthetic practice, improving postoperative oxygenation and re-expanding atelectasis of anesthetized patients.

Keywords

ANESTHESIA, COMPLICATIONS, MECHANICAL VENTILATION, PEEP

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Manobra de recrutamento alveolar em anestesia: como, quando e por que utilizá-la

Alveolar recruitment maneuver in anesthetic practice: how, when and why it may be useful

Luciana Oliveira Gonçalves; Domingos Dias Cicarelli

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