{"id":1500,"date":"2021-02-01T18:00:21","date_gmt":"2021-02-01T21:00:21","guid":{"rendered":"http:\/\/nave.vet.br\/?p=1500"},"modified":"2025-03-09T20:55:23","modified_gmt":"2025-03-09T23:55:23","slug":"ventilacao-mecanica-2","status":"publish","type":"post","link":"https:\/\/nave.vet.br\/en\/video-aulas\/ventilacao-mecanica-2\/","title":{"rendered":"Ventila\u00e7\u00e3o Mec\u00e2nica 2 \u2013 Anestesia e\u0301 o Ba\u0301sico #18"},"content":{"rendered":"<div id=\"advads-2171083563\" class=\"advads-antes-do-post advads-entity-placement\" style=\"margin-bottom: 30px;margin-left: auto;margin-right: auto;text-align: center;\"><div class=\"advads-antes-do-post advads-entity-placement\" style=\"text-align: center;\" id=\"advads-1642823781\"><div id=\"advads-2397891941\"><a href=\"https:\/\/www.sdamed.com\/\" aria-label=\"Banner-SDAMed NAVE\"><img src=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/04\/Banner-SDAMed-NAVE-1.gif?fit=496%2C68&#038;ssl=1\" alt=\"\"  width=\"1000\" height=\"137\"   \/><\/a><\/div><\/div><\/div>\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"1\u20e38\u20e3 VENTILA\u00c7\u00c3O ARTIFICIAL Parte 2 | Anestesia e\u0301 o Ba\u0301sico #18\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/wkihcjXrdHk?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p>Ol\u00e1 tripulantes do NAVE, tudo bem? Nessa aula vamos conversar um pouco mais sobre &#8220;Ventila\u00e7\u00e3o Mec\u00e2nica&#8221;. Na <strong><a href=\"http:\/\/nave.vet.br\/en\/video-aulas\/basico\/ventilacao-mecanica1\/\" class=\"rank-math-link\">primeira aula sobre o assunto<\/a><\/strong> n\u00f3s falamos sobre os alv\u00e9olos, a rela\u00e7\u00e3o entre ventila\u00e7\u00e3o e perfus\u00e3o (V\/Q) e as principais manobras ventilat\u00f3rias. Nessa videoaula vamos falar de outros pontos que influenciam a ventila\u00e7\u00e3o, como press\u00e3o positiva ao final da expira\u00e7\u00e3o (PEEP), recrutamento alveolar, desmame e toxicidade do oxig\u00eanio. <\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"zeep-e-peep\"><strong>ZEEP e PEEP<\/strong> <\/h4>\n\n\n\n<p>Independente da modalidade anest\u00e9sica, seja ciclada \u00e0 press\u00e3o ou a volume, n\u00f3s podemos ter colabamento alveolar na fase expirat\u00f3ria. Quando n\u00e3o utilizamos press\u00e3o positiva ao final da expira\u00e7\u00e3o, ou seja, quando ela \u00e9 zero (ZEEP), as \u00e1reas de shunt aumentam bastante, principalmente em pacientes obesos e\/ou em anestesias prolongadas. <\/p>\n\n\n\n<p>Esse impacto pode ser diminu\u00eddo caso seja utiliza a press\u00e3o positiva ao final da expira\u00e7\u00e3o (PEEP). Cada esp\u00e9cie tem sua rela\u00e7\u00e3o de PEEP, sendo entre 2-5 cm\/H<sub>2<\/sub>O em pequenos animais e acima de 7 cm\/H<sub>2<\/sub>O em grandes animais. Tem um v\u00eddeo bem did\u00e1tico que mostra os pulm\u00f5es em ZEEP e PEEP <a href=\"https:\/\/www.youtube.com\/watch?v=oKH7CtsEgHw&amp;t=1s\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">nesse link aqui<\/a>.<\/p><div id=\"advads-1817796014\" class=\"advads-adsense-in-article advads-entity-placement\"><script async src=\"\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-9687921986569993\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display:block; text-align:center;\" data-ad-client=\"ca-pub-9687921986569993\" \ndata-ad-slot=\"1211285291\" \ndata-ad-layout=\"in-article\"\ndata-ad-format=\"fluid\"><\/ins>\n<script> \n(adsbygoogle = window.adsbygoogle || []).push({}); \n<\/script>\n<\/div>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"recrutamento-alveolar\"><strong>Recrutamento Alveolar<\/strong> <\/h4>\n\n\n\n<p>O recrutamento alveolar \u00e9 uma manobra bem interessante para minimizar as \u00e1reas de shunt pulmonar. Antigamente era utilizada a t\u00e9cnica de &#8220;aumento de volume corrente&#8221;. Essa t\u00e9cnica n\u00e3o \u00e9 adequada pois, na pr\u00e1tica, ela n\u00e3o expande os alv\u00e9olos colabados e pode lesionar os funcionais por volutrauma. Basicamente temos duas t\u00e9cnicas para o retrutamento alveolar:<\/p>\n\n\n\n<p><br>&#8211; <u>Insufla\u00e7\u00e3o Sustentada por Press\u00e3o<\/u>: Essa manobra \u00e9 feita aumentando um pouco mais a press\u00e3o inspirat\u00f3ria e sustentando a fase inspirat\u00f3ria, por at\u00e9 30 segundos, em 3 a 5 ciclos, a cada 30 minutos. Ela \u00e9 eficiente caso seja associada \u00e0 PEEP.<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>&#8211; <u>Escalonamento da PEEP<\/u>: Essa \u00e9 a manobra mais aceita atualmente. S\u00e3o feitos ciclos crescentes de PEEP, a cada 3 ou 4 ciclos ventilat\u00f3rios, mantendo-se a diferen\u00e7a entre a press\u00e3o de pico e a PEEP. A press\u00e3o de pico m\u00e1xima depender\u00e1 da capacidade do paciente e valores de ETCO<sub>2<\/sub>\/PaCO<sub>2<\/sub>. Ap\u00f3s atingirmos o patamar desejado, realizamos o retorno, do mesmo modo.<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div id=\"advads-1654611452\"><a href=\"https:\/\/vetnar.com.br\/courses\/ventilacao-caes-e-gatos\/\" aria-label=\"Adriano Ventilac\u0327a\u0303o\" target=\"_blank\" rel=\"noopener\"><img fetchpriority=\"high\" decoding=\"async\" src=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2025\/03\/Adriano-Ventilacao.jpg?fit=642%2C360&#038;ssl=1\" alt=\"\"  srcset=\"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2025\/03\/Adriano-Ventilacao.jpg?w=642&#038;ssl=1 642w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2025\/03\/Adriano-Ventilacao.jpg?resize=300%2C168&#038;ssl=1 300w, https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2025\/03\/Adriano-Ventilacao.jpg?resize=18%2C10&#038;ssl=1 18w\" sizes=\"(max-width: 642px) 100vw, 642px\" width=\"642\" height=\"360\"   \/><\/a><\/div><\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator aligncenter has-alpha-channel-opacity\"\/>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"desmame\"><strong>Desmame<\/strong><\/h4>\n\n\n\n<p>O desmame \u00e9 feito sempre que colocamos o animal na ventila\u00e7\u00e3o mec\u00e2nica. Ap\u00f3s a revers\u00e3o do bloqueio neuromuscular, com neostigmina e atropina, n\u00f3s diminu\u00edmos a frequ\u00eancia respirat\u00f3ria do ventilador em n\u00edveis m\u00ednimos at\u00e9 que o paciente ganhe autonomia na fun\u00e7\u00e3o respirat\u00f3ria. <\/p>\n\n\n\n<p>O tempo depender\u00e1 de cada paciente e o suporte ventilat\u00f3rio s\u00f3 poder\u00e1 ser finalizado ap\u00f3s a completa autonomia ventilat\u00f3ria por parte do paciente.<\/p>\n\n\n\n<p>Algumas pessoas utilizam um desmame abrupto, literalmente desligando o ventilador, submetendo o animal \u00e0 apneia. Isso realmente funciona, pois haver\u00e1 aumento da PaCO<sub>2<\/sub>, estimulando o centro respirat\u00f3rio. Por\u00e9m, essa manobra n\u00e3o \u00e9 considerada adequada pois a perda imediata de press\u00e3o positiva, ficando por at\u00e9 2-3 minutos assim, far\u00e1 com que as \u00e1rea de shunt aumentem bastante, prejudicando as trocas gasosas.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"toxicidade-do-o2\"><strong>Toxicidade do O<sub>2<\/sub><\/strong><\/h4>\n\n\n\n<p>O excesso de O<sub>2<\/sub> no fornecimento de gases ao paciente \u00e9 delet\u00e9rio para a anestesia. Procedimentos acima de 4 horas, em fra\u00e7\u00e3o inspirada de O<sub>2<\/sub> acima de 0,9, promovem remo\u00e7\u00e3o de nitrog\u00eanio e surfactante, causando colabamento alveolar. <\/p>\n\n\n\n<p>V\u00e1rias estudos j\u00e1 indicaram que a fra\u00e7\u00e3o ideal para a manuten\u00e7\u00e3o ventilat\u00f3ria do paciente est\u00e1 pr\u00f3xima de 0,6 de O<sub>2<\/sub> (60%). Isso far\u00e1 com que haja oferta de O<sub>2<\/sub> suficiente para manter os n\u00edveis de PaO<sub>2<\/sub> acima de 300mmHg, considerados adequados para um paciente em anestesia.<\/p>\n\n\n\n<p>Assista a videoaula para ver mais detalhes sobre o tema!<\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<h6 class=\"wp-block-heading\" id=\"leia-tambem\">Read also about:<\/h6>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"http:\/\/nave.vet.br\/en\/video-aulas\/basico\/bloqueadores_neuromusculares\/\">Bloqueadores Neuromusculares \u2013 Anestesia \u00e9 o B\u00e1sico #19<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/nave.vet.br\/en\/video-aulas\/basico\/ventilacao-mecanica1\/\">Ventila\u00e7\u00e3o Mec\u00e2nica 1 \u2013 Anestesia \u00e9 o B\u00e1sico #17<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/nave.vet.br\/en\/video-aulas\/basico\/equilibrio-acido-base\/\">Acid-Base Balance  #21<\/a><\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p class=\"has-small-font-size\"><em>Find out more:<\/em><br>\u2013 Ambr\u00f3sio AM, Fantoni DT. Ventila\u00e7\u00e3o artificial. In: Luna SPL, Carregaro, AB. Anestesia e Analgesia de Equideos, Ruminantes e Su\u00ednos. 551-562, 201.<br><a rel=\"noreferrer noopener\" href=\"https:\/\/europepmc.org\/article\/med\/11929615\" target=\"_blank\">\u2013 Campbell RS, Davis BR. Pressure-controlled versus volume-controlled ventilation: Does it matter? Resp Care, 47:416-426, 2002.<\/a><br>\u2013 <a href=\"https:\/\/doi.org\/10.2460\/ajvr.79.5.496\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">De Monte et al. Respiratory effects of low versus high tidal volume with or without positive end-expiratory pressure in anesthetized dogs with healthy lungs. <em>Am J Vet Res<\/em>, 79:496-504, 2018.<\/a><br>\u2013 <a href=\"http:\/\/10.1016\/j.vaa.2018.03.007\" class=\"rank-math-link\">Di Bella et al. An alveolar recruitment maneuver followed by positive end-expiratory pressure improves lung function in healthy dogs undergoing laparoscopy. <em>Vet Anaesth Analg<\/em>, 45:818-829, 2018.<\/a> <br>\u2013 <a href=\"https:\/\/doi.org\/10.1016\/j.rvsc.2019.10.016\" target=\"_blank\" rel=\"noopener\">Garc\u00eda-Sanz et al. Comparative effects of open-lung positive end-expiratory pressure (PEEP) and fixed PEEP on respiratory system compliance in the isoflurane anaesthetised healthy dog. <em>Res Vet Sci<\/em>, 127:91-98, 2019.<\/a><br>\u2013 <a href=\"https:\/\/doi.org\/10.1111\/vaa.12074\" class=\"rank-math-link\" target=\"_blank\" rel=\"noopener\">Lopes et al. The effects of different inspired oxygen fractions on gas exchange and Tei\u2010index of myocardial performance in propofol\u2010anesthetized dogs. <em>Vet Anaesth Analg<\/em>, 40:573-583, 2013. <\/a><br>\u2013 <a href=\"http:\/\/10.1093\/bja\/aeg085\" class=\"rank-math-link\">Magnusson &amp; Spahn. New concepts of atelectasis during general anaesthesia. <em>Br J Anaesth<\/em>, 91:61-72, 2003.<\/a><br><a rel=\"noreferrer noopener\" href=\"https:\/\/doi.org\/10.1016\/j.mayocp.2017.05.004\" target=\"_blank\">\u2013 Pham T et al. Mechanical Ventilation: State of the art. Mayo Clin Proc,92:1382-1400,2017.<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p><strong>Suggestions? Thoughts? Comments? Share!<\/strong><\/p>","protected":false},"excerpt":{"rendered":"<p>Nessa segunda videoaula sobre o tema &#8220;Ventila\u00e7\u00e3o Mec\u00e2nica&#8221; n\u00f3s vamos falar de outros pontos que influenciam a ventila\u00e7\u00e3o, como press\u00e3o positiva ao final da expira\u00e7\u00e3o (PEEP), recrutamento alveolar, desmame e&#8230;<\/p>","protected":false},"author":2,"featured_media":1502,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"video","meta":{"give_campaign_id":0,"colormag_page_layout":"default_layout","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[2,1],"tags":[633,14,610,55,659,665,621,624,628,631,664,625,626,657,623,627,629,622,658,630,660,656],"class_list":["post-1500","post","type-post","status-publish","format-video","has-post-thumbnail","hentry","category-video-aulas","category-basico","tag-anestesia-em-caes","tag-anestesia-veterinaria","tag-anestesicos-inalatorios","tag-anestesiologia-veterinaria-2","tag-como-entender-ventilacao-mecanica","tag-intoxicacao-o2","tag-ippv","tag-ippv-modo-ventilatorio","tag-pcv-ventilacao-mecanica","tag-peep","tag-recrutamento-alveolar-como-fazer","tag-simv","tag-vcv-ventilacao-mecanica","tag-ventilacao-anestesia","tag-ventilacao-artificial","tag-ventilacao-ciclada-a-pressao","tag-ventilacao-ciclada-a-volume","tag-ventilacao-mecanica","tag-ventilacao-mecanica-aula","tag-ventilacao-mecanica-veterinaria","tag-ventilacao-veterinaria","tag-zeep","post_format-post-format-video"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/nave.vet.br\/wp-content\/uploads\/2021\/02\/ventilacaoveterinaria.jpg?fit=1280%2C720&ssl=1","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/posts\/1500","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/comments?post=1500"}],"version-history":[{"count":12,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/posts\/1500\/revisions"}],"predecessor-version":[{"id":3780,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/posts\/1500\/revisions\/3780"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/media\/1502"}],"wp:attachment":[{"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/media?parent=1500"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/categories?post=1500"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nave.vet.br\/en\/wp-json\/wp\/v2\/tags?post=1500"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}