Article information
Abstract
Respiratory complications are a significant cause of postoperative morbidity and mortality. Perioperative atelectasis, in particular, affects 90% of surgical patients and its effects can be prolonged due to changes in respiratory mechanics, pulmonary circulation and hypoxaemia. Alveolar collapse is caused by certain predisposing factors, mainly due to compression and absorption mechanisms. Several therapeutic strategies have been proposed to prevent or treat this atelectasis, such as alveolar recruitment manoeuvres, which has become widely used in the last few years. Its application in patients with alveolar collapse, but without a previous significant acute lung lesion has some unusual features. Its use is, therefore, not free of uncertainties and complications. This review describes the frequency, pathophysiology, importance and treatment of perioperative atelectasis. Special attention is paid to treatment with recruitment manoeuvres, so as to provide a basis for their rational and appropriate use.
Keywords:
Atelectasis
Post-operative period
Post-operative complications
Resumen
Las complicaciones respiratorias postoperatorias constituyen una causa importante de morbimortalidad. Las atelectasias perioperatorias, en concreto, afectan hasta al 90% de los pacientes quirúrgicos y su repercusión puede prolongarse en el tiempo en forma de alteraciones de la mecánica respiratoria, de la circulación pulmonar y de hipoxemia. El colapso alveolar se produce en presencia de ciertos factores predisponentes, fundamentalmente por mecanismos de compresión y absorción. Para prevenir o tratar estas atelectasias, se han propuesto diversas estrategias terapéuticas, como las maniobras de reclutamiento alveolar, cuyo uso se ha popularizado en los últimos años. Su aplicación en pacientes con colapso alveolar, pero sin lesión pulmonar aguda previa relevante, presenta ciertas particularidades, por lo que su empleo no está exento de incertidumbres y complicaciones. Esta revisión describe la frecuencia, la fisiopatología, la relevancia y el tratamiento de las atelectasias perioperatorias, y hace especial incidencia en el tratamiento con maniobras de reclutamiento con el objetivo de proporcionar las bases para un empleo racional y adecuado de éstas.
Palabras clave:
Atelectasia
Período postoperatorio
Complicaciones postoperatorias
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