Manobras de hiperinsuflação mecânica e peep-zeep: efeitos na mecânica pulmonar

Abstract

Introduction: In mechanically ventilated patients, some techniques have been widely used for the removal of secretion such as mechanical hyperinflation (MH) and positive end-expiratory pressure maneuver-zero final expiratory pressure (PEEP-ZEEP). HM is used to promote lung inflation passively and in this way optimize compliance, maximize the amount of secretions removed. The PEEP-ZEEP maneuver is a process that produces redistribution of air and alveolar pressure, producing reopening of small airways, alteration of the expiratory flow and displacing the mucus from the distal regions to the bronchi. Objective: To evaluate the efficacy of the mechanical hyperinflation and PEEP-ZEEP maneuvers in pulmonary mechanics. Methods: A controlled, randomized, crossover, and prospective clinical trial performed at the Intensive Care Unit included patients who were dependent on invasive mechanical ventilation and were submitted to an established protocol in which HM and PEEP-ZEEP maneuvers were performed with an interval of 6 hours from each other. The variables analyzed were peak pressure (PPi), plateau pressure (PPL) and dynamic compliance (Cdin). Results: During the collection period, 18 patients were analyzed, as were the variables of pulmonary mechanics - PPi, PPL and Cdin, which did not show a statistically significant difference after the application of each technique (p≤0.05). Conclusion: The techniques of mechanical hyperinflation and PEEP-ZEEP were similar in repercussions in pulmonary mechanics.