Presentación del tema: "Estrategias intraoperatorias de ventilación unipulmonar"— Transcripción de la presentación:
1 Estrategias intraoperatorias de ventilación unipulmonar
2 VENTILACION UNIPULMONAR VOLUMEN CORRIENTEPEEPFIO2HIPERCAPNIARELACION I:EPRESION PICO Y PLATEUMODO VENTILATORIO
3 VOLUMEN TIDAL VOLUMEN TIDAL 4-6 ML/K This form of lung injury results in diffusealveolar damage, increased permeability, pulmonaryoedema, cell contraction and cytokineproductionOLV traditionally has been performed with tidal volumes that are equalto those being used on TLV [4,61]. This practice was recommended, becauselarge tidal volumes were shown to improve oxygenation and decrease shuntfraction during TLV  and OLV, irrespective of PEEP applied . Improvedoxygenation was thought to occur because of end-inspiratory alveolarrecruitment. Excessive tidal volumes (eg, 15 mL/kg) on the other handwere shown to worsen oxygenation, likely because of elevations in PVR resultingin increased shunt flow . However, OLV with high tidal volumes(referring to 10 to 12 mL/kg) has been pervasive for decades, and as suchhas an established safety recordwhich investigated 32 patientsundergoing OLV for thoracotomy. Minute ventilation and PEEP wereidentical between groups, and only tidal volumes were altered. Patientsreceived OLV with 10 mL/kg or 5 mL/kg, both without PEEP. OLV wasassociated with cytokine elevations (tumor necrosis factor a [TNF-a],sICAM-1), but to a lesser degree with low tidal volume ventilation.