PROTECTIVE VENTILATION PROTOCOL IN OBESE PATIENTS: STRATEGIES FOR PULMONARY FUNCTION OPTIMIZATION AND COMPLICATION REDUCTION
Abstract
Obesity imposes severe alterations on respiratory mechanics, making ventilatory management in intensive care a clinical challenge subject to great care variability. The objective of this study was to develop a protective mechanical ventilation protocol for critically ill obese patients. Method: This is an applied methodological study based on a narrative literature review (2020-2025). The evidence supported the creation of an institutional protocol for the Hospital Municipal Ronaldo Gazolla (RJ), aimed at standardizing multidisciplinary care. Results: The developed protocol establishes decisive maneuvers: mandatory pre-oxygenation with Non-Invasive Ventilation (NIV); positioning in Beach Chair or reverse Trendelenburg for intra-abdominal pressure relief; mandatory tidal volume calculation (6-8 mL/kg) by predicted body weight using knee or ulna height; rigorous driving pressure monitoring; individualized PEEP titration; prone positioning as rescue; and immediate prophylactic institution of NIV post-extubation. Conclusion: The instrument translates pathophysiological complexity into a practical bedside algorithm. In a scenario of intensive routine and different levels of staff expertise, the protocol acts as a barrier against empirical errors, reducing care variability, mitigating the risk of Ventilator-Induced Lung Injury (VILI), and paving the way for improved clinical outcomes.
Author Biographies
Fisioterapeuta Residente em Atenção em Terapia Intensiva.
Fisioterapeuta Residente em Atenção em Terapia Intensiva.
Fisioterapeuta Residente da atenção em Terapia Intensiva.
Fisioterapeuta Residente da atenção em Terapia Intensiva.
Fisioterapeuta Residente em Atenção em Terapia Intensiva.
Graduanda de Fisioterapia.
Fisioterapeuta. Mestre em Modelos de Decisão e Saúde. Doutor em Empidemiologia em Saúde Pública Ensp/FIOCRUZ.
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