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Medicina crítica (Colegio Mexicano de Medicina Crítica)

versão impressa ISSN 2448-8909

Resumo

CARDOSO-RAMIREZ, Marco Antonio et al. Impact of alveolar distention pressure on days under mechanical ventilation in patients with acute respiratory distress syndrome (SDRA). Med. crít. (Col. Mex. Med. Crít.) [online]. 2020, vol.34, n.4, pp.231-237.  Epub 25-Abr-2022. ISSN 2448-8909.  https://doi.org/10.35366/95878.

Introduction:

ARDS is characterized by a heterogeneity of damage in the lung parenchyma and the association between tidal volume (Vt) and static lung compliance (Cst) can be evaluated by DP. Most studies on DP and ARDS focus on mortality, showing a lower percentage of survival while the level of DP is higher, however, it is unknown until today whether the control of DP impacts on other objectives such as decrease of days under mechanical ventilation.

Material and methods:

A systematic review of medical articles in Pubmed, EMBASE and Medigraphic was carried out with key words: driving pressure and acute respiratory distress syndrome to relate DP and days free of mechanical ventilation in the main studies on ARDS, analyzing the respiratory variables reported by these publications.

Results:

The relationship was found in the systematized review; that patients ventilated with ARDS and DP < 15 cmH2O was associated with fewer days of mechanical ventilation with a p = 0.03, patients with ARDS and DP < 15 cmH2O comparing mortality at 90 days, decreased their mortality with p ≤ 0.0001, patients without ARDS and PD < 15 cm cmH2O comparing mortality at 28 days with p = 0.005, patients with ARDS and DP association of postoperative pulmonary complications and DP < 15 cmH2O, DP values greater than 15 cmH2O was associated with barotrauma, postoperative pulmonary infections, with a p ≤ 0.0001 of, in survival and mortality at 90 days, correlated with a odds ratio (OR) of 0.60 in favor of DP less than 15 cmH2O and in mortality at 28 days with an OR of 0.29, in favor of DP below 15 cmH2O.

Discussion:

DP is associated with mortality in a directly proportional way.

Conclusion:

Lower values of DP are associated with fewer days of mechanical ventilation.

Palavras-chave : Driving pressure; acute respiratory distress syndrome; mechanical ventilation; ventilator-induced lung injury.

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