PERIOPERATIVE PROTECTIVE MECHANICAL VENTILATION:VENTILATION WITHOUT WALLS.

Abstract

Objective: To systematize the theoretical foundations that supports the Perioperative Protective Mechanical
Ventilation strategies.  Material and Method: A bibliographic review was carried out in academic databases: Google Academic, SciELO, Lilacs, Dialnet, PubMed, Resargate, Elseviery, Road and Infomed after the use of keywords from the MESH and BIREME thesaurus. Result: Mechanical ventilation during the operative act has the potential risk of suffering damage to the ultrastructure and lung function. Volume trauma is one of the elements most strongly associated with the
appearance of respiratory distress syndrome (ARDS). Low-volume ventilation indicated a significant decrease
in mortality in patients with ARDS. Positive pressure at the end of expiration in healthy lungs reduces the
appearance of chemical mediators during intraoperative ventilation, preventing alveolus collapse and the
appearance of atelectasis. The adequate ventilation strategy recommends the use of tidal volumes of 6 to 8
ml / kg of predicted weight, respiratory rates up to 25 to maintain plateu pressure equal to or less than 20,
use of inspiratory fraction of oxygen always less than 80% and positive pressure at the end of expiration at
least 5 cm of water. Conclusion: Scientific evidence justifies the use of low tidal volume with positive pressure at the end of expiration to avoid alveolar collapse in routine ventilation, during anesthesia in patients with healthy lungs. The authors recommend estimating the tidal volume according to the predicted weight and height of the
patient.