Anales de Pediatría Este patrón ventilatorio condiciona una hipercapnia permisiva, que por lo general es bien tolerada con una sedación adecuada. Hipercapnia progresiva: PaCO2 > 50 mmHg. .. Menos VT (VA e hipercapnia “ permisiva”) Menos flujo (> I con < E, auto-PEEP); Razón. con liberación de presión en la vía aérea, ventilación con relación I:E inversa, hipercapnia permisiva, y ventilación de alta frecuencia.

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The evidence shows that direct mechanical injury is the main responsible of VILI and its remote biological amplification.

Diplomado Cuidado Critico Cardio Neonatos Pediatria | PubHTML5

The cyclic transpulmonary pressures that exceed lung inflation capacity can damage the epithelium-alveolar barrier, especially in association with insufficient PEEP to keep the mechanically unstable alveolar units open. At present time, therapies that can interfere and modulate efficiently the trigger of lediatria events leading to VILI have not been developed.

Thus, the only therapy available is the cautious use of mechanical ventilation MV. The wise implementation of MV strategy will result in a lower stress and strain of lung parenchyma, with reduction in its biological impact. Hence, pediatrla main message of this review is that the way we ventilate our patients is decisive in their outcome and we must try to minimize VILI from the moment we start to ventilate our patient.

In the present communication, we attempt to review basic concepts, anatomic-functional aspects of this mechanical phenomenon and its biological consequences. Clinical interventions that allow to attenuate the impact of ventilatory support are described.

Volumen corriente o tidal. Volumen de reserva espiratorio. Numerosos otros condicionantes influyen en la susceptibilidad al desarrollo de DIVM. Un ajuste adecuado de la PEEP es el pilar del concepto de ” open lung “. Si incrementamos la PEEP, podemos enfrentar dos situaciones: Son de mayor utilidad en la etapa aguda del SDRA. Podemos reconocer la siguiente secuencia en el desarrollo del DIVM: Hasta la fecha no hipfrcapnia ha demostrado que el empleo de elevados niveles de PEEP sea mejor que el empleo de niveles moderados 42 ; los resultados dispares observados probablemente se deban a no limitar Pm en estrategias de alto PEEP.


What is the daily practice of mechanical ventilation in pediatric intensive care units?

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Daño pulmonar inducido por ventilación mecánica y estrategia ventilatoria convencional protectora

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