Effects of alveolar recruitment maneuvers on the level of oxygenation in pediatric patients under invasive mechanical ventilation Efectos de las maniobras de reclutamiento alveolar sobre el nivel de oxigenación en pacientes pediátricos bajo ventilación mecánica invasiva

Abstract

Introduction. Mechanical ventilation (MV) has contributed to improve survival in different clinical situations of high complexity, but despite its great advances, it can increase the rate of morbidity and mortality when used improperly. Despite knowing the benefits, effects and contraindications of alveolar recruitment maneuvers (RM) to improve the oxygenation index (OI) in patients in critical conditions with a ventilatory support requirement, the optimal recruitment strategies for ARDS have not been established in the pediatric population. Method. A descriptive study that collects information in a systematic way, collecting scientific articles (pilot studies, controlled and / or randomized clinical trials, systematic trials and publications in indexed journals). Results 6 articles developed the maneuver of recruitment with stepped or incremental PEEP, 3 articles developed the maneuver of recruitment of sustained inspiration (SI) and 5 articles developed more than two recruitment maneuvers in which there is the use of CPAP, SI, incremental PEEP, sighs, prone positioning, maximum recruitment strategy and prolonged recruitment. Despite possible short-term beneficial effects on oxygenation, MRI in ventilated and critically ill children may produce an increase in circulating cytokines, suggesting that repeated MRI may lead to a prolonged increase in systemic cytokines, which It has been associated with multi-organ dysfunction síndrome